Provider Demographics
NPI:1659573905
Name:GATEWAYS PERCY VILLAGE B
Entity Type:Organization
Organization Name:GATEWAYS PERCY VILLAGE B
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-644-2000
Mailing Address - Street 1:3455 PERCY ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1716
Mailing Address - Country:US
Mailing Address - Phone:323-268-2100
Mailing Address - Fax:
Practice Address - Street 1:1891 EFFIE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-1711
Practice Address - Country:US
Practice Address - Phone:323-644-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198600612323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA168AMedicare Oscar/Certification