Provider Demographics
NPI:1154428290
Name:GATEWAY HOMES, INC.
Entity type:Organization
Organization Name:GATEWAY HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-767-0292
Mailing Address - Street 1:4905 DICKENS RD STE 106
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1953
Mailing Address - Country:US
Mailing Address - Phone:571-550-0767
Mailing Address - Fax:804-269-5003
Practice Address - Street 1:11901 REEDY BRANCH RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-4235
Practice Address - Country:US
Practice Address - Phone:804-590-0828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA673-03-001323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010075521Medicaid