Provider Demographics
NPI:1841241171
Name:GGNSC TUNKHANNOCK LP
Entity Type:Organization
Organization Name:GGNSC TUNKHANNOCK LP
Other - Org Name:GOLDEN LIVINGCENTER - TUNKHANNOCK
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 1:30 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-1701
Mailing Address - Country:US
Mailing Address - Phone:570-836-5166
Mailing Address - Fax:570-836-7756
Practice Address - Street 1:30 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-1701
Practice Address - Country:US
Practice Address - Phone:570-836-5166
Practice Address - Fax:570-836-7756
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
PA551002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101548690Medicaid
PA1015486900001Medicaid
PA30965OtherGEISINGER HEALTH PLAN
PA000000132408OtherTHREE RIVERS HEALTH PLAN
PA1526889OtherGATEWAY HEALTH PLAN
CA395433Medicare Oscar/Certification
PA395433Medicare Oscar/Certification