Provider Demographics
NPI:1578253738
Name:GATE CITY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:GATE CITY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:603-759-7436
Mailing Address - Street 1:21 TECHNOLOGY WAY STE 2W5A
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3245
Mailing Address - Country:US
Mailing Address - Phone:603-759-7436
Mailing Address - Fax:
Practice Address - Street 1:21 TECHNOLOGY WAY STE 2W5A
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3245
Practice Address - Country:US
Practice Address - Phone:603-759-7436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health