Provider Demographics
NPI:1881232411
Name:GATEWAY PROFESSIONAL SERVICES, PC
Entity Type:Organization
Organization Name:GATEWAY PROFESSIONAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF MANAGED CARE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-663-1130
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:
Mailing Address - Fax:
Practice Address - Street 1:400 MERCY LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-2447
Practice Address - Country:US
Practice Address - Phone:877-381-6538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY PROFESSIONAL SERVICES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-13
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty