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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659570778
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	:	518-284-1621
Fax Number	:	518-381-9068

Provider Business Practice Location Address
First Line	:	284 TROY RD
Second Line	:
City	:	RENSSELAER
State	:	NY
Zip	:	12144-9474
Country	:	US
Telephone Number	:	518-284-1621
Fax Number	:	518-381-9068

Authorized Official
Title or Position	:	LHA AS RECEIVER
Name	:	MR. DAVID LAWLER
Credential	:
Telephone Number	:	203-305-2318

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	10/09/2007

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