Provider Demographics
NPI:1710158134
Name:GATEWAY-LONGVIEW
Entity Type:Organization
Organization Name:GATEWAY-LONGVIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:716-783-3100
Mailing Address - Street 1:6350 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5821
Mailing Address - Country:US
Mailing Address - Phone:716-883-4531
Mailing Address - Fax:716-883-4591
Practice Address - Street 1:605 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1044
Practice Address - Country:US
Practice Address - Phone:716-883-4531
Practice Address - Fax:716-883-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00356538Medicaid