Provider Demographics
NPI:1144855081
Name:GATEWAY PROFESSIONAL SERVICES, PC
Entity type:Organization
Organization Name:GATEWAY PROFESSIONAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF MANAGED CARE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-663-1130
Mailing Address - Street 1:55 E JACKSON BLVD STE 1500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4184
Mailing Address - Country:US
Mailing Address - Phone:312-663-1130
Mailing Address - Fax:312-663-0504
Practice Address - Street 1:4028 DEMPSTER ST UNIT 100
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2156
Practice Address - Country:US
Practice Address - Phone:877-381-6538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty