Provider Demographics
NPI:1942939426
Name:STONEGATE HEALTHCARE LLC
Entity Type:Organization
Organization Name:STONEGATE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:J
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-410-5283
Mailing Address - Street 1:150 OBERLIN AVE N STE 6
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4535
Mailing Address - Country:US
Mailing Address - Phone:732-800-6005
Mailing Address - Fax:
Practice Address - Street 1:118 JERRY SELBY DR
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-4734
Practice Address - Country:US
Practice Address - Phone:870-364-1534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility