Provider Demographics
NPI:1679281026
Name:GATEWAYS BOYS AND GIRLS HOME INC
Entity Type:Organization
Organization Name:GATEWAYS BOYS AND GIRLS HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LONGSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-538-4673
Mailing Address - Street 1:1836 TILDEN RD
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:MO
Mailing Address - Zip Code:65656-8515
Mailing Address - Country:US
Mailing Address - Phone:417-538-4673
Mailing Address - Fax:417-538-4007
Practice Address - Street 1:1836 TILDEN RD
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:MO
Practice Address - Zip Code:65656-8515
Practice Address - Country:US
Practice Address - Phone:417-538-4673
Practice Address - Fax:417-538-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children