Organization
GATEWAY BEHAVIORAL HEALTH SERVICES
Active
Organization
GATEWAY BEHAVIORAL HEALTH SERVICES
Active
Other names
Gatway BHS - Liberty GH B
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM PARKS CPA CFO (CHIEF FINANCIAL OFFICER)
(912) 554-8464
Entity
Organization
Contact information
Practice address
760 S MAIN ST # B, HINESVILLE, GA 31313-4613
(912) 368-7472
(912) 368-7473
Mailing address
700 COASTAL VILLAGE DR, BRUNSWICK, GA 31520-1974
(912) 264-0979
(912) 264-5965
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000622553AR
—
GA
Enumeration date
03/13/2007
Last updated
10/20/2011
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