Healthcare Provider Details

I. General information

NPI: 1689662330
Provider Name (Legal Business Name): WESTGATE PREMIER HEALTHCARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PETERSEN AVE
SAN JOSE CA
95129-4844
US

IV. Provider business mailing address

1601 PETERSEN AVE
SAN JOSE CA
95129-4844
US

V. Phone/Fax

Practice location:
  • Phone: 408-253-7502
  • Fax: 408-252-6034
Mailing address:
  • Phone: 408-253-7502
  • Fax: 408-252-6034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. EDIL V. BASA
Title or Position: EXECUTIVE DIRECTOR
Credential: NHA
Phone: 408-253-7502