MEDICARE: NORTHGATE POSTACUTE CARE

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	010000374	CA
2	314000000X	Skilled Nursing Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010000374	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1689053274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHGATE POSTACUTE CARE

Provider Business Mailing Address
First Line	:	721 N EUCLID ST STE 200
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-4116
Country	:	US
Telephone Number	:	424-349-7108
Fax Number	:	562-457-5584

Provider Business Practice Location Address
First Line	:	40 PROFESSIONAL CENTER PARKWAY
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-2703
Country	:	US
Telephone Number	:	415-479-1230
Fax Number	:	562-457-5584

Authorized Official
Title or Position	:	CEO
Name	:	MR. MANEESH BANSAL
Credential	:	M.D.
Telephone Number	:	424-349-7108

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	12/24/2025

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Directions to “NORTHGATE POSTACUTE CARE ” Practice Location

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