Provider Demographics
NPI:1396152807
Name:GATEWAY CENTER FOR THE ARTS
Entity type:Organization
Organization Name:GATEWAY CENTER FOR THE ARTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HELM
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP,BCBA-LBA
Authorized Official - Phone:636-583-0788
Mailing Address - Street 1:1281 N HIGHWAY 47
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1495
Mailing Address - Country:US
Mailing Address - Phone:636-583-0788
Mailing Address - Fax:636-583-0921
Practice Address - Street 1:1281 N HIGHWAY 47
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1495
Practice Address - Country:US
Practice Address - Phone:636-583-0788
Practice Address - Fax:636-583-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013028552320900000X, 103K00000X
MO114517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO120313143819554Medicare PIN