Organization
GATEWAY ADDICTIONOLOGY SERVICES, PLLC
Active
Other names
Gateway Recovery Institute
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN J. DELISIO M.D. (PRESIDENT/CEO)
(480) 981-2405
Entity
Organization
Contact information
Practice address
4862 E. BASELINE ROAD, SUITE 108, MESA, AZ 85206
(480) 981-2405
(480) 981-2407
Mailing address
4838 E. BASELINE ROAD, SUITE 108, MESA, AZ 85206-4672
(480) 981-2400
(480) 981-2407
Taxonomy
Speciality
Code
Description
License number
State
207LA0401X
Addiction Medicine (Anesthesiology) Physician
43504
AZ
324500000X
Substance Abuse Rehabilitation Facility
Primary
BH5407
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699221879
NPI
AZ
Enumeration date
08/29/2016
Last updated
06/21/2018
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