Provider Demographics
NPI:1740655661
Name:GATEWAYS HOSPITAL AND MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:GATEWAYS HOSPITAL AND MENTAL HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:323-644-2000
Mailing Address - Street 1:1891 EFFIE STREET
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-1711
Mailing Address - Country:US
Mailing Address - Phone:323-644-2000
Mailing Address - Fax:
Practice Address - Street 1:1891 EFFIE STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-1711
Practice Address - Country:US
Practice Address - Phone:323-644-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAYS HOSPITAL AND MENTAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-03
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000058283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-4028OtherMEDICARE (NOT SURE WHAT TYPE, IT JUST SAYS MEDICARE NUMBER)