Provider Demographics
NPI:1912567967
Name:GATEWAY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:GATEWAY COMMUNITY SERVICES
Other - Org Name:GATEWAY COMMUNITY SERVICES- LIBBY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCOUNTS/ BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAYWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-727-2512
Mailing Address - Street 1:26 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3106
Mailing Address - Country:US
Mailing Address - Phone:406-727-2512
Mailing Address - Fax:
Practice Address - Street 1:711 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-1903
Practice Address - Country:US
Practice Address - Phone:406-293-7731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY COMMUNITY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health