Provider Demographics
NPI:1124079587
Name:GGNSC CAMP HILL III LP
Entity type:Organization
Organization Name:GGNSC CAMP HILL III LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:46 ERFORD RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2303
Mailing Address - Country:US
Mailing Address - Phone:717-763-7361
Mailing Address - Fax:717-730-9109
Practice Address - Street 1:46 ERFORD RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2303
Practice Address - Country:US
Practice Address - Phone:717-763-7361
Practice Address - Fax:717-730-9109
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
PA030502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395123OtherCAPITAL BLUE CROSS
PA2138OtherHIGHMARK CENTRAL FREEDOM
PA53104OtherGEISINGER HEALTH PLAN
PA1508047OtherGATEWAY HEALTH PLAN
PA101553090Medicaid
PA000000119180OtherTHREE RIVERS HEALTH PLAN
PA1015530900001Medicaid
PA85630OtherHEALTH AMERICA
PA1015530900001Medicaid
PA101553090Medicaid