| Gateway Community Services, Inc. | |
|
2133 Broadway Ave Jacksonville FL 32209-7513 | |
| (904) 361-5010 | |
| (904) 384-2299 |
| Full Name | Gateway Community Services, Inc. |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2133 Broadway Ave, Jacksonville, Florida |
| Authorized Official Name and Position | Jennifer Vanzandt (CFO) |
| Authorized Official Contact | 9043874661 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Community Services, Inc. 555 Stockton St Jacksonville FL 32204-2534 Ph: (904) 387-4661 | Gateway Community Services, Inc. 2133 Broadway Ave Jacksonville FL 32209-7513 Ph: (904) 361-5010 |
| NPI Number | 1124783477 |
|---|---|
| Provider Enumeration Date | 11/02/2021 |
| Last Update Date | 05/23/2024 |
| Certification Date | 08/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124783477 | NPI | - | NPPES |
| 1659541654 | Other | FL | NPI |
| 1619411279 | Other | FL | NPI |
| 1316376585 | Other | FL | NPI |
| 1689252314 | Other | FL | NPI |
| 1811393499 | Other | FL | NPI |
| 1427184308 | Other | FL | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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