Provider Demographics
NPI:1457303687
Name:GGNSC EL DORADO III LLC
Entity Type:Organization
Organization Name:GGNSC EL DORADO III LLC
Other - Org Name:GOLDEN LIVINGCENTER - EL DORADO
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 1:2415 W HILLSBORO ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-6815
Mailing Address - Country:US
Mailing Address - Phone:870-863-5034
Mailing Address - Fax:870-863-5092
Practice Address - Street 1:2415 W HILLSBORO ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6815
Practice Address - Country:US
Practice Address - Phone:870-863-5034
Practice Address - Fax:870-863-5092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR816314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
045182Medicare ID - Type Unspecified