Provider Demographics
NPI:1952824567
Name:GATE LODGE OF FLORIDA, LLC
Entity Type:Organization
Organization Name:GATE LODGE OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROWLING
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:214-283-8500
Mailing Address - Street 1:933 45TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2413
Mailing Address - Country:US
Mailing Address - Phone:561-841-1142
Mailing Address - Fax:561-841-1001
Practice Address - Street 1:3395 11TH CT
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5054
Practice Address - Country:US
Practice Address - Phone:772-617-1717
Practice Address - Fax:772-778-9032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORIGINS BEHAVIORAL HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-25
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3147221878801261QR0405X, 276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder