Provider Demographics
NPI:1699726059
Name:GGNSC CANONSBURG LP
Entity type:Organization
Organization Name:GGNSC CANONSBURG 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 1:201 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2368
Mailing Address - Country:US
Mailing Address - Phone:724-746-1300
Mailing Address - Fax:724-746-0522
Practice Address - Street 1:201 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-2368
Practice Address - Country:US
Practice Address - Phone:724-746-1300
Practice Address - Fax:724-746-0522
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
PA193302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1515034OtherGATEWAY HEALTH PLAN
PA000000102951OtherTHREE RIVERS HEALTH PLAN
PA0553OtherHIGHMARK WESTERN PA
PA101548958Medicaid
PA1015489580001Medicaid
PA218342OtherUPMC
PA523556OtherUS HEALTH
PA93569OtherHEALTH AMERICA
PA0553OtherHIGHMARK WESTERN PA
PA523556OtherUS HEALTH