Provider Demographics
NPI:1205828373
Name:NORTHGATE CARE CENTER, INC.
Entity Type:Organization
Organization Name:NORTHGATE CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MANEESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BANSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-924-9618
Mailing Address - Street 1:40 PROFESSIONAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2703
Mailing Address - Country:US
Mailing Address - Phone:415-479-1230
Mailing Address - Fax:415-492-0398
Practice Address - Street 1:40 PROFESSIONAL PARKWAY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2703
Practice Address - Country:US
Practice Address - Phone:415-479-1230
Practice Address - Fax:415-492-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010000347314000000X
CA314000000X
CA010000374332B00000X, 332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1189870007OtherSIGNA
CAZZR18405HMedicaid
CA5308680001Medicare NSC
CA1189870007OtherSIGNA