Provider Demographics
NPI:1790736999
Name:GGNSC WARREN II LP
Entity Type:Organization
Organization Name:GGNSC WARREN II LP
Other - Org Name:GOLDEN LIVINGCENTER - CENTRAL
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 1:121 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2910
Mailing Address - Country:US
Mailing Address - Phone:814-726-1420
Mailing Address - Fax:814-726-9054
Practice Address - Street 1:121 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2910
Practice Address - Country:US
Practice Address - Phone:814-726-1420
Practice Address - Fax:814-726-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA230402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015584350001Medicaid
PA315392OtherUPMC
NY00895212Medicaid
PA238587OtherHEALTH AMERICA
PA1523924OtherGATEWAY HEALTH PLAN
PA92711OtherTHREE RIVERS HEALTH PLAN
PA0833OtherHIGHMARK WESTERN PA
PA0833OtherHIGHMARK WESTERN PA