Provider Demographics
NPI:1184675563
Name:GGNSC ERIE II LP
Entity Type:Organization
Organization Name:GGNSC ERIE II LP
Other - Org Name:GOLDEN LIVINGCENTER - ERIE
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 1:2686 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1851
Mailing Address - Country:US
Mailing Address - Phone:814-453-6641
Mailing Address - Fax:814-453-5546
Practice Address - Street 1:2686 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1851
Practice Address - Country:US
Practice Address - Phone:814-453-6641
Practice Address - Fax:814-453-5546
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
PA020602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0671OtherHIGHMARK WESTERN PA
PA1015495340001Medicaid
PA1008144500093OtherION HEALTH
PA126211OtherHEALTH AMERICA
PA1504366OtherGATEWAY HEALTH PLAN
NY00895212Medicaid
PA000000085257OtherTHREE RIVERS HEALTH PLAN
PA000084OtherUPMC
PA0671OtherHIGHMARK WESTERN PA