| Gateway Foundation, Inc-cmhc | |
|
1300 Lincoln Ave Jacksonville IL 62650-3112 | |
| (877) 381-6538 | |
| Not Available |
| Full Name | Gateway Foundation, Inc-cmhc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1300 Lincoln Ave, Jacksonville, Illinois |
| Authorized Official Name and Position | Latina Russell (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 3126631130 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Foundation, Inc-cmhc 55 E Jackson Blvd Ste 1500 Chicago IL 60604-4184 Ph: (312) 663-1130 | Gateway Foundation, Inc-cmhc 1300 Lincoln Ave Jacksonville IL 62650-3112 Ph: (877) 381-6538 |
| NPI Number | 1487471785 |
|---|---|
| Provider Enumeration Date | 09/26/2024 |
| Last Update Date | 09/26/2024 |
| Certification Date | 09/26/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487471785 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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