Provider Demographics
NPI:1790769347
Name:NORTHGATE HEALTHCARE SERVICES CORPORATION
Entity Type:Organization
Organization Name:NORTHGATE HEALTHCARE SERVICES CORPORATION
Other - Org Name:WOODBRIAR OF WILMINGTON REHABILITATION & SKILLED NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-658-2700
Mailing Address - Street 1:90 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-3039
Mailing Address - Country:US
Mailing Address - Phone:978-658-2700
Mailing Address - Fax:978-657-0015
Practice Address - Street 1:90 WEST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-3039
Practice Address - Country:US
Practice Address - Phone:978-658-2700
Practice Address - Fax:978-657-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0947314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0920878Medicaid
225568Medicare Oscar/Certification
MA0920878Medicaid