Healthcare Provider Details

I. General information

NPI: 1205828373
Provider Name (Legal Business Name): NORTHGATE CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PROFESSIONAL PARKWAY
SAN RAFAEL CA
94903-2703
US

IV. Provider business mailing address

40 PROFESSIONAL PARKWAY
SAN RAFAEL CA
94903-2703
US

V. Phone/Fax

Practice location:
  • Phone: 415-479-1230
  • Fax: 415-492-0398
Mailing address:
  • Phone: 415-479-1230
  • Fax: 415-492-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number010000347
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number010000374
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number010000374
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number010000374
License Number StateCA

VIII. Authorized Official

Name: MR. MANEESH BANSAL
Title or Position: CEO
Credential: M.D.
Phone: 562-924-9618