Provider Demographics
NPI:1902857212
Name:GGNSC SCRANTON LP
Entity Type:Organization
Organization Name:GGNSC SCRANTON LP
Other - Org Name:GOLDEN LIVINGCENTER - SCRANTON
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 1:824 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1002
Mailing Address - Country:US
Mailing Address - Phone:570-346-5704
Mailing Address - Fax:570-347-5057
Practice Address - Street 1:824 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1002
Practice Address - Country:US
Practice Address - Phone:570-346-5704
Practice Address - Fax:570-347-5057
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
PA010102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000111867OtherTHREE RIVERS HEALTH PLAN
PA1526897OtherGATEWAY HEALTH PLAN
PA30986OtherGEISINGER HEALTH PLAN
PA101551541Medicaid
PA1015515410001Medicaid
PA0263OtherBLUE CROSS NORTHEAST PA
PA000000111867OtherTHREE RIVERS HEALTH PLAN
CA395273Medicare Oscar/Certification