1790769347 NPI number — NORTHGATE HEALTHCARE SERVICES CORPORATION

Table of content: (NPI 1790769347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790769347 NPI number — NORTHGATE HEALTHCARE SERVICES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHGATE HEALTHCARE SERVICES CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WOODBRIAR OF WILMINGTON REHABILITATION & SKILLED NURSING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790769347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 WEST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01887-3039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-658-2700
Provider Business Mailing Address Fax Number:
978-657-0015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 WEST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01887-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-658-2700
Provider Business Practice Location Address Fax Number:
978-657-0015
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SARGENT
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-658-2700

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0947 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0920878 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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