Provider Demographics
NPI:1982655189
Name:GGNSC WARREN KINZUA VALLEY LP
Entity Type:Organization
Organization Name:GGNSC WARREN KINZUA VALLEY LP
Other - Org Name:GOLDEN LIVINGCENTER - KINZUA
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 1:205 WATER ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2307
Mailing Address - Country:US
Mailing Address - Phone:814-726-0820
Mailing Address - Fax:814-726-9717
Practice Address - Street 1:205 WATER ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2307
Practice Address - Country:US
Practice Address - Phone:814-726-0820
Practice Address - Fax:814-726-9717
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
PA071402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000092721OtherTHREE RIVERS HEALTH PLAN
PA1015495990001Medicaid
NY00833349Medicaid
PA1523922OtherGATEWAY HEALTH PLAN
PA101549599Medicaid
PA410362OtherUPMC
PA126207OtherHEALTH AMERICA
PA101549599Medicaid
CA395363Medicare Oscar/Certification