NPI 1831508522

Gateway Detroit

Organisation Preferred Provider Organization Detroit, MI

Practice location

Address: 11457 Shoemaker St, Detroit, MI 48213-3418
Phone: (313) 331-3435
Fax: (313) 924-0609

Authorised official

Name: Frederick Carr
Title: Social Worker/Case Manager
Phone: (313) 331-3435

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 6803086187 (MI)

Other Preferred Provider Organization providers in Michigan →

Registry record

NPI: 1831508522
Entity type: Organization
NPI issued: 6 Aug 2014
Record last updated: 6 Aug 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.