Provider Demographics
NPI:1487647889
Name:HIGHGATE LTC MANGEMENT LLC
Entity Type:Organization
Organization Name:HIGHGATE LTC MANGEMENT LLC
Other - Org Name:NORTHWOODS REHAB AND EXTENDED CARE FACILITIES AT TROY
Other - Org Type:Other Name
Authorized Official - Title/Position:LHA AS RECEIVER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-305-2318
Mailing Address - Street 1:100 NEW TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-1412
Mailing Address - Country:US
Mailing Address - Phone:518-235-1410
Mailing Address - Fax:518-235-1632
Practice Address - Street 1:100 NEW TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-1412
Practice Address - Country:US
Practice Address - Phone:518-235-1410
Practice Address - Fax:518-235-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4161302N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473836Medicaid
NY00473836Medicaid