Provider Demographics
NPI:1093766388
Name:GGNSC HIBBING LLC
Entity Type:Organization
Organization Name:GGNSC HIBBING LLC
Other - Org Name:GOLDEN LIVINGCENTER - GOLDEN CREST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
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 1:2413 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2101
Mailing Address - Country:US
Mailing Address - Phone:218-262-1081
Mailing Address - Fax:218-262-4976
Practice Address - Street 1:2413 1ST AVE
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2101
Practice Address - Country:US
Practice Address - Phone:218-262-1081
Practice Address - Fax:218-262-4976
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
MN332031314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7122508OtherMEDICA CHOICE
MN7100279OtherMEDICA SELECTCARE
MNNH0159OtherUCARE MN
MN245309OtherSECURITY HEALTH PLAN
MN9R71GGOtherBLUE CROSS MINNESOTA
MN115069OtherHEALTH PARTNERS MN
MN9R71GGOtherBLUE CROSS MINNESOTA