NPIMap

Organization Active NPI

Gateway Behavioral Health Services

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Brunswick, GA
National Provider Identifier
1306979000
Registry record updated Oct 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
GATEWAY BEHAVIORAL HEALTH SERVICES
Practice address
119 Hidden Lakes Drive
Brunswick, GA 31525
Phone
(912) 261-3981
Fax
(912) 261-3982
NPI assigned
Mar 13, 2007
Last updated
Oct 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. William Parks, CPA CFO
Title
Chief Financial Officer
Phone
(912) 554-8464

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X NU Primary

Addresses

Primary practice location

119 Hidden Lakes Drive
Brunswick, GA 31525

Mailing address

700 Coastal Village Dr
Suite 2
Brunswick, GA 31520-1974
Phone (912) 554-8510

Other identifiers 1

IdentifierTypeStateIssuer
000622553BFMedicaidGA

Other names 1

  • Gateway BHS - Glynn Hidden Lakes GH Other name

National Provider Directory

National Provider Directory
Tax ID family
Marsh Haven72 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318896000000",
    "number": "1306979000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 COASTAL VILLAGE DR",
            "address_2": "SUITE 2",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315201974",
            "telephone_number": "912-554-8510",
            "fax_number": "912-264-5965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 HIDDEN LAKES DRIVE",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "31525",
            "telephone_number": "912-261-3981",
            "fax_number": "912-261-3982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2011-10-18",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "912-554-8464",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA CFO"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000622553BF",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gateway BHS - Glynn Hidden Lakes GH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Brunswick, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.