NPIMap

Organization Active NPI

Gateway Foundation, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bloomington, IL
National Provider Identifier
1750082194
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
GATEWAY FOUNDATION, INC
Doing business as
Gateway Foundation, Inc
Practice address
404 N Hershey Rd Ste B
Bloomington, IL 61704-3560
Phone
(877) 381-6538
NPI assigned
Mar 13, 2023
Last updated
Aug 6, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GATEWAY FOUNDATION, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Authorized official

Name
Jeremy Klemanski
Title
Ceo
Phone
(312) 663-1130

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary
Substance Abuse Rehabilitation Facility 324500000X NU

Addresses

Primary practice location

404 N Hershey Rd Ste B
Bloomington, IL 61704-3560

Mailing address

55 E Jackson Blvd
Chicago, IL 60604-4466
Phone (312) 663-1130

Other names 1

  • Gateway Foundation, Inc Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Gateway Foundation Inc - BHC45 organizations share this tax ID, including this one
Part of
Gateway Foundation Inc - BHC

Other organizations with this tax ID 44

Organizations that report the same tax identification number in the National Provider Directory.

View all 44

Locations

404 N Hershey Rd
Ste C
Bloomington, IL 61704

NPI Registry JSON

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1750082194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 E JACKSON BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606044466",
            "telephone_number": "312-663-1130",
            "fax_number": "312-663-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 N HERSHEY RD STE B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043560",
            "telephone_number": "877-381-6538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY FOUNDATION, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GATEWAY FOUNDATION, INC",
        "enumeration_date": "2023-03-13",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "KLEMANSKI",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "312-663-1130"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gateway Foundation, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.