Organization
GATEWAY BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID MUSONERA (MEMBER)
(602) 559-6807
Entity
Organization
Contact information
Practice address
4444 W NORTHERN AVE BLDG E, GLENDALE, AZ 85301-1683
(623) 251-4663
Mailing address
1814 S 116TH LN, AVONDALE, AZ 85323-6276
(602) 559-6807
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
06/02/2023
Last updated
06/14/2023
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