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Organization

GATEWAY ADDICTION CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ALBERT F SANCHEZ (CEO)
(479) 263-2690
Entity
Organization

Contact information

Practice address
304 BOULDER ST, PAWNEE, OK 74058-4028
(918) 771-0437
Mailing address
PO BOX 334, BIXBY, OK 74008-0334
(918) 771-0437

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner

Other

Enumeration date
09/19/2016
Last updated
10/13/2016
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