Healthcare Provider Details

I. General information

NPI: 1942251301
Provider Name (Legal Business Name): GGNSC MONROEVILLE 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

4142 MONROEVILLE BLVD
MONROEVILLE PA
15146-2608
US

IV. Provider business mailing address

4142 MONROEVILLE BLVD
MONROEVILLE PA
15146-2608
US

V. Phone/Fax

Practice location:
  • Phone: 412-856-7570
  • Fax: 412-373-4383
Mailing address:
  • Phone: 412-856-7570
  • Fax: 412-373-4383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number026102
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1512805
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGATEWAY HEALTH PLAN
# 2
Identifier112827
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHEALTH AMERICA
# 3
Identifier000000076004
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerTHREE RIVERS HEALTH PLAN
# 4
Identifier1015498100001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 5
Identifier0593
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK WESTERN PA
# 6
Identifier101549810
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 7
Identifier107736
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC

VIII. Authorized Official

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