Provider Demographics
NPI:1194776427
Name:GGNSC SUNBURY LP
Entity type:Organization
Organization Name:GGNSC SUNBURY 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 1:1040 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-2403
Mailing Address - Country:US
Mailing Address - Phone:570-286-6922
Mailing Address - Fax:570-286-6817
Practice Address - Street 1:1040 MARKET ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2403
Practice Address - Country:US
Practice Address - Phone:570-286-6922
Practice Address - Fax:570-286-6817
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
PA130502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30966OtherGEISINGER HEALTH PLAN
PA000000131601OtherTHREE RIVERS HEALTH PLAN
PA101558533Medicaid
PA1015585330001Medicaid
PA1509803OtherGATEWAY HEALTH PLAN
PA395482OtherCAPITAL BLUE CROSS
PA84253OtherHEALTH AMERICA
CA395482Medicare Oscar/Certification
PA30966OtherGEISINGER HEALTH PLAN