Provider Demographics
NPI:1427349208
Name:GATEWAY FOUNDATION, INC
Entity type:Organization
Organization Name:GATEWAY FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-663-1130
Mailing Address - Street 1:55 E. JACKSON, BLVD., SUITE 1500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4102
Mailing Address - Country:US
Mailing Address - Phone:312-663-1130
Mailing Address - Fax:312-663-0504
Practice Address - Street 1:2200 LAKE VICTORIA DRIVE
Practice Address - Street 2:MAIN FLOOR WEST
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5596
Practice Address - Country:US
Practice Address - Phone:217-529-9266
Practice Address - Fax:217-529-9151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY FOUNDATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-27
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-0538-0020-A261QR0405X
ILC/A-0538-0020-A324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder