Provider Demographics
NPI:1669424800
Name:GGNSC CAMDEN LLC
Entity type:Organization
Organization Name:GGNSC CAMDEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
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 1:900 MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-4626
Mailing Address - Country:US
Mailing Address - Phone:870-836-6833
Mailing Address - Fax:870-837-2732
Practice Address - Street 1:900 MAGNOLIA RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4626
Practice Address - Country:US
Practice Address - Phone:870-836-6833
Practice Address - Fax:870-837-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR807314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159 986 311Medicaid
AR045189Medicare Oscar/Certification
045189Medicare ID - Type Unspecified