Provider Demographics
NPI:1073564274
Name:GGNSC MEADVILLE LP
Entity Type:Organization
Organization Name:GGNSC MEADVILLE LP
Other - Org Name:GOLDEN LIVINGCENTER - MEADVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC. OF THE GP
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RASMUSSEN-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-201-4835
Mailing Address - Street 1:14714 PARK AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-9400
Mailing Address - Country:US
Mailing Address - Phone:814-337-4228
Mailing Address - Fax:814-333-9331
Practice Address - Street 1:14714 PARK AVENUE EXT
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-9400
Practice Address - Country:US
Practice Address - Phone:814-337-4228
Practice Address - Fax:814-333-9331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA131702314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1523926OtherGATEWAY HEALTH PLAN
PA0492OtherHIGHMARK WESTERN PA
PA000000098905OtherTHREE RIVERS HEALTH PLAN
PA1015497400001Medicaid
PA126212OtherHEALTH AMERICA
PA126212OtherHEALTH AMERICA