Provider Demographics
NPI:1750332086
Name:GGNSC LEWISTOWN LP
Entity Type:Organization
Organization Name:GGNSC LEWISTOWN LP
Other - Org Name:GOLDEN LIVINGCENTER - WILLIAM PENN
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 1:163 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1245
Mailing Address - Country:US
Mailing Address - Phone:717-248-3941
Mailing Address - Fax:717-242-2280
Practice Address - Street 1:163 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1245
Practice Address - Country:US
Practice Address - Phone:717-248-3941
Practice Address - Fax:717-242-2280
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
PA750602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015518820001Medicaid
PA000000098244OtherTHREE RIVERS HEALTH PLAN
PA1526899OtherGATEWAY HEALTH PLAN
PA101551882Medicaid
PA90745OtherHEALTH AMERICA
PA30970OtherGEISINGER HEALTH PLAN
PA395335OtherCAPITAL BLUE CROSS
PA395335OtherCAPITAL BLUE CROSS
PA90745OtherHEALTH AMERICA