Provider Demographics
NPI:1053499152
Name:NORTHGATE HME HLTH CRE IN
Entity Type:Organization
Organization Name:NORTHGATE HME HLTH CRE IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-767-2273
Mailing Address - Street 1:3522 CLOVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35633-1339
Mailing Address - Country:US
Mailing Address - Phone:256-767-2273
Mailing Address - Fax:256-767-2273
Practice Address - Street 1:3522 CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-1339
Practice Address - Country:US
Practice Address - Phone:256-767-2273
Practice Address - Fax:256-767-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL277332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3558427Medicaid
AL56514OtherBLUE CROSS
AL0129790001Medicare NSC
TN3558427Medicaid