Healthcare Provider Details

I. General information

NPI: 1033160494
Provider Name (Legal Business Name): GGNSC DOYLESTOWN LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 MAPLE AVE
DOYLESTOWN PA
18901-4414
US

IV. Provider business mailing address

432 MAPLE AVE
DOYLESTOWN PA
18901-4414
US

V. Phone/Fax

Practice location:
  • Phone: 215-345-1452
  • Fax: 215-345-6816
Mailing address:
  • Phone: 215-345-1452
  • Fax: 215-345-6816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number040502
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier101555228
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier0005513000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerINDEPENDENCE BLUE CROSS
# 3
Identifier1015552280001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: HOLLY A. RASMUSSEN-JONES
Title or Position: SEC. OF THE GP
Credential:
Phone: 479-201-4835