| Gateway To Change | |
|
2319 W Capitol Dr Milwaukee WI 53206-1919 | |
| (414) 442-2033 | |
| (414) 442-2167 |
| Full Name | Gateway To Change |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2319 W Capitol Dr, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Glenda O Hampton (EXECDUTIVE DIRECTOR) |
| Authorized Official Contact | 4144422033 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway To Change 2319 W Capitol Dr Milwaukee WI 53206-1919 Ph: (414) 442-2033 | Gateway To Change 2319 W Capitol Dr Milwaukee WI 53206-1919 Ph: (414) 442-2033 |
| NPI Number | 1023281987 |
|---|---|
| Provider Enumeration Date | 04/10/2008 |
| Last Update Date | 04/10/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023281987 | NPI | - | NPPES |
| 42232700 | Medicaid | WI | |
| 42232721 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2479 (Wisconsin) | Primary |
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