Northgate Care Center, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

NORTHGATE CARE CENTER, INC.

Practice address

40 Professional Parkway
San Rafael, CA 94903-2703

Phone

(415) 479-1230

Fax

(415) 492-0398

NPI assigned

Aug 16, 2005

Last updated

Oct 14, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Maneesh Bansal, M.D.

Title

Ceo

Phone

(562) 924-9618

Specialties & licenses 5

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444780800000",
    "number": "1205828373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 PROFESSIONAL PARKWAY",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032703",
            "telephone_number": "415-479-1230",
            "fax_number": "415-492-0398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 PROFESSIONAL PARKWAY",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032703",
            "telephone_number": "415-479-1230",
            "fax_number": "415-492-0398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHGATE CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2015-10-14",
        "status": "A",
        "authorized_official_last_name": "BANSAL",
        "authorized_official_first_name": "MANEESH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-924-9618",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "010000347",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "010000374",
            "primary": false
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "CA",
            "license": "010000374",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "CA",
            "license": "010000374",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIGNA",
            "identifier": "1189870007",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR18405H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.