Provider Demographics
NPI:1760118079
Name:GATEWAY RECOVERY CENTER II, LLC
Entity Type:Organization
Organization Name:GATEWAY RECOVERY CENTER II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:LADC, MBA
Authorized Official - Phone:651-587-7181
Mailing Address - Street 1:1663 CELIA RD
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3604
Mailing Address - Country:US
Mailing Address - Phone:651-698-7358
Mailing Address - Fax:
Practice Address - Street 1:6840 78TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2760
Practice Address - Country:US
Practice Address - Phone:651-587-7181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder