Provider Demographics
NPI:1609991900
Name:GATEWOOD CHILDREN'S HOME INC.,
Entity Type:Organization
Organization Name:GATEWOOD CHILDREN'S HOME INC.,
Other - Org Name:GATEWOOD CHILDREN'S HOME INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF ADMIN OFFICIER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIVA
Authorized Official - Middle Name:HUTCHISON
Authorized Official - Last Name:GATEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:804-329-8600
Mailing Address - Street 1:9109 MINGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-5832
Mailing Address - Country:US
Mailing Address - Phone:804-329-8600
Mailing Address - Fax:804-550-5601
Practice Address - Street 1:3229 PURVIS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-1259
Practice Address - Country:US
Practice Address - Phone:804-329-8600
Practice Address - Fax:804-329-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VASS26805320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities