Provider Demographics
NPI:1447660089
Name:GATEWAY JUVENILE DIVERSION PROJECT, INC.
Entity type:Organization
Organization Name:GATEWAY JUVENILE DIVERSION PROJECT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPITTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-498-9892
Mailing Address - Street 1:37 NORTH MAYSVILLE
Mailing Address - Street 2:
Mailing Address - City:MT STERLIG
Mailing Address - State:KY
Mailing Address - Zip Code:40353
Mailing Address - Country:US
Mailing Address - Phone:859-498-9892
Mailing Address - Fax:859-498-0316
Practice Address - Street 1:37 NORTH MAYSVILLE ST
Practice Address - Street 2:
Practice Address - City:MT STERLIG
Practice Address - State:KY
Practice Address - Zip Code:40353
Practice Address - Country:US
Practice Address - Phone:859-498-9892
Practice Address - Fax:859-498-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health