Provider Demographics
NPI:1992756225
Name:GGNSC EAST STROUDSBURG LP
Entity type:Organization
Organization Name:GGNSC EAST STROUDSBURG 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 1:221 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3005
Mailing Address - Country:US
Mailing Address - Phone:570-421-6200
Mailing Address - Fax:570-421-6718
Practice Address - Street 1:221 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3005
Practice Address - Country:US
Practice Address - Phone:570-421-6200
Practice Address - Fax:570-421-6718
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
PA194002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000130686OtherTHREE RIVERS HEALTH PLAN
PA101551597Medicaid
PA30984OtherGEISINGER HEALTH PLAN
PA1015515970001Medicaid
PA1526895OtherGATEWAY HEALTH PLAN
PA30984OtherGEISINGER HEALTH PLAN
PA1526895OtherGATEWAY HEALTH PLAN