Provider Demographics
NPI:1659570778
Name:HIGHGATE LTC MANAGEMENT LLC
Entity Type:Organization
Organization Name:HIGHGATE LTC MANAGEMENT LLC
Other - Org Name:NORTHWOODS AT ROSEWOOD
Other - Org Type:Doing Business As
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 1:284 TROY RD
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-9474
Mailing Address - Country:US
Mailing Address - Phone:518-284-1621
Mailing Address - Fax:518-381-9068
Practice Address - Street 1:284 TROY RD
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-9474
Practice Address - Country:US
Practice Address - Phone:518-284-1621
Practice Address - Fax:518-381-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01073376Medicaid