Provider Demographics
NPI:1962498246
Name:HIGHGATE LTC MANAGEMENT LLC
Entity Type:Organization
Organization Name:HIGHGATE LTC MANAGEMENT LLC
Other - Org Name:NORTHWOODS REHAB AND ECF AT HILLTOP
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:LAWLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-305-2318
Mailing Address - Street 1:1805 PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-3923
Mailing Address - Country:US
Mailing Address - Phone:518-374-2212
Mailing Address - Fax:518-374-4330
Practice Address - Street 1:1805 PROVIDENCE AVE
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-3923
Practice Address - Country:US
Practice Address - Phone:518-374-2212
Practice Address - Fax:518-374-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4652301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01122765Medicaid
NY01122765Medicaid