Provider Demographics
NPI:1568634244
Name:OPENGATE INC.
Entity Type:Organization
Organization Name:OPENGATE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HULTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-277-5350
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-0419
Mailing Address - Country:US
Mailing Address - Phone:914-277-5350
Mailing Address - Fax:
Practice Address - Street 1:357 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504-1808
Practice Address - Country:US
Practice Address - Phone:917-277-5350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7512446310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02752803Medicaid