Provider Demographics
NPI:1902857360
Name:GGNSC WILKES-BARRE EAST MOUNTAIN LP
Entity Type:Organization
Organization Name:GGNSC WILKES-BARRE EAST MOUNTAIN LP
Other - Org Name:GOLDEN LIVINGCENTER - EAST MOUNTAIN
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 1:101 E MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7911
Mailing Address - Country:US
Mailing Address - Phone:570-825-5894
Mailing Address - Fax:570-822-2175
Practice Address - Street 1:101 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-7911
Practice Address - Country:US
Practice Address - Phone:570-825-5894
Practice Address - Fax:570-822-2175
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
PA026502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015491310001Medicaid
PA1526892OtherGATEWAY HEALTH PLAN
PA30935OtherGEISINGER HEALTH PLAN
PA0229OtherBLUE CROSS NORTHEAST PA
PA101549131Medicaid
PA85623OtherHEALTH AMERICA
PA000000113402OtherTHREE RIVERS HEALTH PLAN
PA85623OtherHEALTH AMERICA
PA101549131Medicaid