Organization
GATEWAY TO CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GLENDA O HAMPTON SAC IT (EXECDUTIVE DIRECTOR)
(414) 442-2033
Entity
Organization
Contact information
Practice address
2319 W CAPITOL DR, MILWAUKEE, WI 53206-1919
(414) 442-2033
(414) 442-2167
Mailing address
2319 W CAPITOL DR, MILWAUKEE, WI 53206-1919
(414) 442-2033
(414) 442-2167
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2479
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42232700
—
WI
05
—
42232721
—
WI
Enumeration date
04/10/2008
Last updated
04/10/2008
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