Provider Demographics
NPI:1952532145
Name:GATEWAY INTEGRATIVE SERVICES, INC.
Entity Type:Organization
Organization Name:GATEWAY INTEGRATIVE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONTAVIUS
Authorized Official - Middle Name:KENTWAN
Authorized Official - Last Name:BIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-593-1320
Mailing Address - Street 1:PO BOX 20702
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-0702
Mailing Address - Country:US
Mailing Address - Phone:404-593-1320
Mailing Address - Fax:252-321-4829
Practice Address - Street 1:2470 EMERALD PL
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5786
Practice Address - Country:US
Practice Address - Phone:404-593-1320
Practice Address - Fax:252-321-4829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health