Organization
NORTHGATE SERVICES OF MISSOURI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLAUDE E LEE (VICE PRESIDENT CFO)
(205) 391-3600
Entity
Organization
Contact information
Practice address
961 FAIRFAX PARK, TUSCALOOSA, AL 35406-2805
(205) 345-8858
(205) 345-7991
Mailing address
961 FAIRFAX PARK, TUSCALOOSA, AL 35406-2805
(205) 345-8858
(205) 345-7991
Taxonomy
Speciality
Code
Description
License number
State
332BN1400X
Nursing Facility Supplies (DME)
Primary
630016343
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009926990
—
AL
05
—
141656741
—
AR
Enumeration date
07/03/2006
Last updated
10/11/2010
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