Gateway Foundation, Inc.

NPI #1205682119 in Peoria, Illinois

Provider Information

NPI Number: 1205682119
Entity Type: Organization
Organization Name: Gateway Foundation, Inc.
Primary Specialty: Clinic/Center - Rehabilitation, Substance Use Disorder
Enumeration Date: Apr 30, 2024
Last Updated: Apr 30, 2024

Practice Location

Address: 4812 N SHERIDAN RD
City: Peoria
State: Illinois
ZIP Code: 61614-5969
Phone: (877) 381-6538

Authorized Official

Name: LATINA RUSSELL
Title: CREDENTIALING SPECIALIST
Phone: (312) 663-1130

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Rehabilitation, Substance Use Disorder — Rehabilitation, Substance Use Disorder	261QR0405X	Primary

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