Provider Demographics
NPI:1386695617
Name:GGNSC POTTSVILLE LP
Entity type:Organization
Organization Name:GGNSC POTTSVILLE LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY 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 1:2401 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-1833
Mailing Address - Country:US
Mailing Address - Phone:570-622-3982
Mailing Address - Fax:570-622-2872
Practice Address - Street 1:2401 W MARKET ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1833
Practice Address - Country:US
Practice Address - Phone:570-622-3982
Practice Address - Fax:570-622-2872
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
PA510202314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101558506Medicaid
PA41416OtherGEISINGER HEALTH PLAN
PA1015585060001Medicaid
PA000000131327OtherTHREE RIVERS HEALTH PLAN
PA395252OtherCAPITAL BLUE CROSS
PA1526891OtherGATEWAY HEALTH PLAN
PA1526891OtherGATEWAY HEALTH PLAN
PA101558506Medicaid