# GATEWAY DETROITEAST

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184033128
- **Authorized official:** ELIZABETH CICHON (CLINICAL DIRECTOR)
- **Authorized official phone:** (313) 331-3435

## Contact information

- **Practice address:** 6309 MACK AVE, DETROIT, MI 48207-2302
- **Practice address phone:** (313) 921-4700
- **Practice address fax:** (313) 921-1660
- **Mailing address:** 6309 MACK AVE, DETROIT, MI 48207-2302
- **Mailing address phone:** (313) 921-4700
- **Mailing address fax:** (313) 921-1660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 6802072589 | MI | Yes |

## Other

- **Enumeration date:** 08/04/2014
- **Last updated:** 08/04/2014