Provider Demographics
NPI:1265233027
Name:GATEWAY COMMUNITY CHARTERS
Entity type:Organization
Organization Name:GATEWAY COMMUNITY CHARTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-286-5129
Mailing Address - Street 1:5112 ARNOLD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652-1075
Mailing Address - Country:US
Mailing Address - Phone:916-286-5129
Mailing Address - Fax:
Practice Address - Street 1:5112 ARNOLD AVE STE A
Practice Address - Street 2:
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-1075
Practice Address - Country:US
Practice Address - Phone:916-286-5129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health