Provider Demographics
NPI:1851342232
Name:GGNSC MT. LEBANON LP
Entity Type:Organization
Organization Name:GGNSC MT. LEBANON LP
Other - Org Name:GOLDEN LIVINGCENTER - MT. LEBANON
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 1:350 OLD GILKESON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1063
Mailing Address - Country:US
Mailing Address - Phone:412-257-4444
Mailing Address - Fax:412-257-8226
Practice Address - Street 1:350 OLD GILKESON RD
Practice Address - Street 2:
Practice Address - City:MOUNT LEBANON
Practice Address - State:PA
Practice Address - Zip Code:15228-1063
Practice Address - Country:US
Practice Address - Phone:412-257-4444
Practice Address - Fax:412-257-8226
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
PA137202-PI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0688OtherHIGHMARK WESTERN PA
PA000000079447OtherTHREE RIVERS HEALTH PLAN
PA100274OtherHEALTH AMERICA
PA1015499550001Medicaid
PA1506777OtherGATEWAY HEALTH PLAN
PA101549955Medicaid
PA302053OtherUPMC
PA0688OtherHIGHMARK WESTERN PA
PA1015499550001Medicaid