Gateway Addictionology Services, PLLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

BH5407 Issued in AZ

Legal business name

GATEWAY ADDICTIONOLOGY SERVICES, PLLC

Practice address

4862 E. Baseline Road
Suite 108
Mesa, AZ 85206

Phone

(480) 981-2405

Fax

(480) 981-2407

NPI assigned

Aug 29, 2016

Organization subpart

No

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

Authorized official

Name

Brian J. Delisio, M.D.

Title

President/Ceo

Phone

(480) 981-2405

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Gateway Recovery Institute Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shawn E Sullivan, MD

  • Anesthesiology Physician
  • Mesa, AZ
  • NPI 1437358835

  Addiction Medicine

  NPD (past)

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

{
    "created_epoch": "1472428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1699221879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4838 E. BASELINE ROAD",
            "address_2": "SUITE 108",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064672",
            "telephone_number": "480-981-2400",
            "fax_number": "480-981-2407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4862 E. BASELINE ROAD",
            "address_2": "SUITE 108",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85206",
            "telephone_number": "480-981-2405",
            "fax_number": "480-981-2407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY ADDICTIONOLOGY SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-29",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "DELISIO",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "480-981-2405",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Addiction Medicine",
            "state": "AZ",
            "license": "43504",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": "BH5407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1699221879",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gateway Recovery Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maureen Gaston, F.N.P.
• Raul A Gatchalian, MD
• Jonathan Ryan Gates, MC, LPC
• Kimberly R Gates, AUD.
• Lamesha M Gates
• Gateway Anesthesia and Pain Associates PLLC
• Gateway Physical Therapy LLC
• Gateway Smiles, LLP
• Gateway Wellness Center, LLC
• Virginia Waithira Gatundu, LPC

• Substance Abuse Rehabilitation Facility in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Substance Abuse Rehabilitation Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.