Provider Demographics
NPI:1487152344
Name:GATEWAY FAMILY SERVICES OF ILLINOIS
Entity type:Organization
Organization Name:GATEWAY FAMILY SERVICES OF ILLINOIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO AND LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REMOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-649-0492
Mailing Address - Street 1:7757 US ROUTE 136
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:IL
Mailing Address - Zip Code:61865-3047
Mailing Address - Country:US
Mailing Address - Phone:217-649-0492
Mailing Address - Fax:217-987-6386
Practice Address - Street 1:7757 US ROUTE 136
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:IL
Practice Address - Zip Code:61865-3047
Practice Address - Country:US
Practice Address - Phone:217-649-0492
Practice Address - Fax:217-987-6386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009566101Y00000X, 101YP2500X
261QM0850X, 261QM0855X
TX585151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health