Provider Demographics
NPI:1689053274
Name:NORTHGATE POSTACUTE CARE
Entity Type:Organization
Organization Name:NORTHGATE POSTACUTE CARE
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:424-349-7108
Mailing Address - Street 1:16660 PARAMOUNT BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5457
Mailing Address - Country:US
Mailing Address - Phone:424-349-7108
Mailing Address - Fax:
Practice Address - Street 1:40 PROFESSIONAL CENTER 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:415-507-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010000374314000000X
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA010000374OtherLICENSE NUMBER
CA056430Medicare Oscar/Certification