=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659368827
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH GATE HEALTH CARE FACILITY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2005
-----------------------------------------------------
Last Update Date | 01/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7264 NASH RD
-----------------------------------------------------
City | NORTH TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14120-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-694-7700
-----------------------------------------------------
Fax | 716-694-7720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7264 NASH RD
-----------------------------------------------------
City | NORTH TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14120-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-694-7700
-----------------------------------------------------
Fax | 716-694-7720
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. RALPH ROSSO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-829-1554
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 3160301N
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------