Provider Demographics
NPI:1124783477
Name:GATEWAY COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:GATEWAY COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VANZANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-387-4661
Mailing Address - Street 1:555 STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-2534
Mailing Address - Country:US
Mailing Address - Phone:904-387-4661
Mailing Address - Fax:904-389-8758
Practice Address - Street 1:2133 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-7513
Practice Address - Country:US
Practice Address - Phone:904-361-5010
Practice Address - Fax:904-384-2299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY COMMUNITY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-02
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1659541654OtherNPI
FL1619411279OtherNPI
FL1316376585OtherNPI
FL1689252314OtherNPI
FL1811393499OtherNPI
FL1427184308OtherNPI