Provider Demographics
NPI:1982842274
Name:GATEWAYS, PA
Entity Type:Organization
Organization Name:GATEWAYS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LADC
Authorized Official - Phone:207-532-3222
Mailing Address - Street 1:4 MARKET SQ
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1735
Mailing Address - Country:US
Mailing Address - Phone:207-532-3222
Mailing Address - Fax:207-532-3288
Practice Address - Street 1:4 MARKET SQ
Practice Address - Street 2:SUITE 1
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1735
Practice Address - Country:US
Practice Address - Phone:207-532-3222
Practice Address - Fax:207-532-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME582260251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME424610000Medicaid
ME424610000Medicaid