MEDICARE: HIGHGATE LTC MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	4152302N	NY

General Provider Information

NPI Number	:	1306831565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHGATE LTC MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	284 TROY RD
Second Line	:
City	:	RENSSELAER
State	:	NY
Zip	:	12144-9474
Country	:	US
Telephone Number	:	518-286-1621
Fax Number	:	518-286-2739

Provider Business Practice Location Address
First Line	:	284 TROY RD
Second Line	:
City	:	RENSSELAER
State	:	NY
Zip	:	12144-9474
Country	:	US
Telephone Number	:	518-286-1621
Fax Number	:	518-286-2739

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. NANCY JO EMERICK
Credential	:	M.S.
Telephone Number	:	518-286-1621

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	08/22/2020

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