Provider Demographics
NPI:1467403782
Name:GGNSC SHIPPENVILLE LP
Entity Type:Organization
Organization Name:GGNSC SHIPPENVILLE LP
Other - Org Name:GOLDEN LIVINGCENTER - SHIPPENVILLE
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 1:21158 PAINT BLVD
Mailing Address - Street 2:
Mailing Address - City:SHIPPENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16254-4024
Mailing Address - Country:US
Mailing Address - Phone:814-226-5660
Mailing Address - Fax:814-226-9896
Practice Address - Street 1:21158 PAINT BLVD
Practice Address - Street 2:
Practice Address - City:SHIPPENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16254-4024
Practice Address - Country:US
Practice Address - Phone:814-226-5660
Practice Address - Fax:814-226-9896
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
PA026002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA312367OtherUPMC
PA101558130Medicaid
PA1518751OtherGATEWAY HEALTH PLAN
PA126258OtherHEALTH AMERICA
PA000000079446OtherTHREE RIVERS HEALTH PLAN
PA0654OtherHIGHMARK WESTERN PA
PA1015581300001Medicaid
PA395607Medicare Oscar/Certification
PA000000079446OtherTHREE RIVERS HEALTH PLAN