Provider Demographics
NPI:1841241254
Name:GGNSC PHOENIXVILLE II LP
Entity Type:Organization
Organization Name:GGNSC PHOENIXVILLE II LP
Other - Org Name:GOLDEN LIVINGCENTER - PHOENIXVILLE
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 1:833 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4420
Mailing Address - Country:US
Mailing Address - Phone:610-933-5867
Mailing Address - Fax:610-935-8328
Practice Address - Street 1:833 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4420
Practice Address - Country:US
Practice Address - Phone:610-933-5867
Practice Address - Fax:610-935-8328
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
PA160702314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101554730Medicaid
PA0005375000OtherINDEPENDENCE BLUE CROSS
PA1015547300001Medicaid
PA1015547300001Medicaid
PA0005375000OtherINDEPENDENCE BLUE CROSS