Provider Demographics
NPI:1538119573
Name:GGNSC HARRISBURG LP
Entity type:Organization
Organization Name:GGNSC HARRISBURG 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 1:3625 N PROGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9690
Mailing Address - Country:US
Mailing Address - Phone:717-652-2345
Mailing Address - Fax:717-652-8325
Practice Address - Street 1:3625 N PROGRESS AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9690
Practice Address - Country:US
Practice Address - Phone:717-652-2345
Practice Address - Fax:717-652-8325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA022002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015529140001Medicaid
PA1523454OtherGATEWAY HEALTH PLAN
PA169934OtherHEALTH AMERICA
PA2141OtherHIGHMARK CENTRAL FREEDOM
PA395142OtherCAPITAL BLUE CROSS
PA53101OtherGEISINGER HEALTH PLAN
PA000000119183OtherTHREE RIVERS HEALTH PLAN
PA101552914Medicaid
PA395142OtherCAPITAL BLUE CROSS
PA1523454OtherGATEWAY HEALTH PLAN