Provider Demographics
NPI:1093766305
Name:GGNSC ROSEMONT LP
Entity Type:Organization
Organization Name:GGNSC ROSEMONT LP
Other - Org Name:GOLDEN LIVINGCENTER - ROSEMONT
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 1:35 ROSEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2717
Mailing Address - Country:US
Mailing Address - Phone:610-525-1500
Mailing Address - Fax:610-525-4131
Practice Address - Street 1:35 ROSEMONT AVE
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:PA
Practice Address - Zip Code:19010-2717
Practice Address - Country:US
Practice Address - Phone:610-525-1500
Practice Address - Fax:610-525-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA181402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101554928Medicaid
PA1015549280001Medicaid
PA0005316000OtherINDEPENDENCE BLUE CROSS
PA0005316000OtherINDEPENDENCE BLUE CROSS
PA395193Medicare Oscar/Certification