Organization
NORTHGATE CARE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MANEESH BANSAL M.D. (CEO)
(562) 924-9618
Entity
Organization
Contact information
Practice address
40 PROFESSIONAL PARKWAY, SAN RAFAEL, CA 94903-2703
(415) 479-1230
(415) 492-0398
Mailing address
40 PROFESSIONAL PARKWAY, SAN RAFAEL, CA 94903-2703
(415) 479-1230
(415) 492-0398
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
010000347
CA
314000000X
Skilled Nursing Facility
Primary
—
CA
332B00000X
Durable Medical Equipment & Medical Supplies
010000374
CA
332BN1400X
Nursing Facility Supplies (DME)
010000374
CA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
010000374
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1189870007
SIGNA
CA
05
—
ZZR18405H
—
CA
Enumeration date
08/16/2005
Last updated
10/14/2015
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