Healthcare Provider Details

I. General information

NPI: 1457409914
Provider Name (Legal Business Name): SOUTHGATE HEALTH CARE CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 S PENNSVILLE AUBURN RD
CARNEYS POINT NJ
08069-2961
US

IV. Provider business mailing address

449 S PENNSVILLE AUBURN RD
CARNEYS POINT NJ
08069-2961
US

V. Phone/Fax

Practice location:
  • Phone: 856-299-8900
  • Fax: 856-299-9273
Mailing address:
  • Phone: 856-299-8900
  • Fax: 856-299-9273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061706
License Number StateNJ

VIII. Authorized Official

Name: SUSAN M. LOVE
Title or Position: ADMINISTRATOR
Credential:
Phone: 856-299-8900