Provider Demographics
NPI:1710482815
Name:GATEWAY FOUNDATION, INC.
Entity Type:Organization
Organization Name:GATEWAY FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ENNIS
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-445-4833
Mailing Address - Street 1:55 E JACKSON BLVD STE 1500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4184
Mailing Address - Country:US
Mailing Address - Phone:678-445-4833
Mailing Address - Fax:
Practice Address - Street 1:415 N DEARBORN ST STE 510
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4626
Practice Address - Country:US
Practice Address - Phone:312-464-9451
Practice Address - Fax:312-464-9554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY FOUNDATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder