Provider Demographics
NPI:1982200275
Name:HOLGATE CARE CENTER, LLC
Entity Type:Organization
Organization Name:HOLGATE CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCLEERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-238-0715
Mailing Address - Street 1:600 JOE E BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLGATE
Mailing Address - State:OH
Mailing Address - Zip Code:43527-9803
Mailing Address - Country:US
Mailing Address - Phone:419-238-0715
Mailing Address - Fax:
Practice Address - Street 1:600 JOE E BROWN AVE
Practice Address - Street 2:
Practice Address - City:HOLGATE
Practice Address - State:OH
Practice Address - Zip Code:43527-9803
Practice Address - Country:US
Practice Address - Phone:419-238-0715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085589Medicaid