Provider Demographics
NPI:1881891356
Name:GATEWAY COMMUNITY HEALTH
Entity type:Organization
Organization Name:GATEWAY COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-263-2360
Mailing Address - Street 1:3011 W GRAND BLVD FL 20
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3022
Mailing Address - Country:US
Mailing Address - Phone:313-262-5100
Mailing Address - Fax:313-875-4715
Practice Address - Street 1:3011 W GRAND BLVD FL 20
Practice Address - Street 2:SUITE 2000
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3022
Practice Address - Country:US
Practice Address - Phone:313-262-5100
Practice Address - Fax:313-875-4715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3119549Medicaid