Provider Demographics
NPI:1720604564
Name:GATEWAY RESIDENTIAL PROGRAMS GINGERBLOSSOM HOUSE
Entity Type:Organization
Organization Name:GATEWAY RESIDENTIAL PROGRAMS GINGERBLOSSOM HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BEESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:916-782-1111
Mailing Address - Street 1:1780 VERNON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6311
Mailing Address - Country:US
Mailing Address - Phone:916-782-1111
Mailing Address - Fax:916-782-4544
Practice Address - Street 1:7605 GINGERBLOSSOM DR
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-1918
Practice Address - Country:US
Practice Address - Phone:916-722-7952
Practice Address - Fax:916-782-4544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY RESIDENTIAL PROGRAMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-17
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness