Provider Demographics
NPI:1275164402
Name:GATEWAY CASE MANAGEMENT SERVICES
Entity Type:Organization
Organization Name:GATEWAY CASE MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PREVILMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-320-4053
Mailing Address - Street 1:14611 SOUTHERN BLVD UNIT 412
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-6819
Mailing Address - Country:US
Mailing Address - Phone:561-320-4053
Mailing Address - Fax:
Practice Address - Street 1:2006 CROSS BREEZE DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8075
Practice Address - Country:US
Practice Address - Phone:561-320-4053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY FIRST COMMUNITY OUTREACH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management