Provider Demographics
NPI:1366494510
Name:GGNSC MONTICELLO LLC
Entity Type:Organization
Organization Name:GGNSC MONTICELLO LLC
Other - Org Name:GOLDEN LIVINGCENTER - MONTICELLO
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 1:1194 N CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-4133
Mailing Address - Country:US
Mailing Address - Phone:870-367-6852
Mailing Address - Fax:870-367-3910
Practice Address - Street 1:1194 N CHESTER ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4133
Practice Address - Country:US
Practice Address - Phone:870-367-6852
Practice Address - Fax:870-367-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR815314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160 209 311Medicaid
045176Medicare ID - Type Unspecified
AR160 209 311Medicaid