Provider Demographics
NPI:1568413946
Name:GGNSC WAYNESBURG LP
Entity Type:Organization
Organization Name:GGNSC WAYNESBURG LP
Other - Org Name:GOLDEN LIVINGCENTER - WAYNESBURG
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 1:300 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8243
Mailing Address - Country:US
Mailing Address - Phone:724-852-2020
Mailing Address - Fax:724-852-1488
Practice Address - Street 1:300 CENTER AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8243
Practice Address - Country:US
Practice Address - Phone:724-852-2020
Practice Address - Fax:724-852-1488
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
PA074602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0597OtherHIGHMARK WESTERN PA
PA101551800Medicaid
PA1015518000001Medicaid
PA216286OtherUPMC
PA395247OtherCAPITAL BLUE CROSS
PA000000070701OtherTHREE RIVERS HEALTH PLAN
PA118300OtherHEALTH AMERICA
PA1511419OtherGATEWAY HEALTH PLAN
PA1015518000001Medicaid
PA395675Medicare Oscar/Certification