Healthcare Provider Details

I. General information

NPI: 1790736999
Provider Name (Legal Business Name): GGNSC WARREN II LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CENTRAL AVE
WARREN PA
16365-2910
US

IV. Provider business mailing address

121 CENTRAL AVE
WARREN PA
16365-2910
US

V. Phone/Fax

Practice location:
  • Phone: 814-726-1420
  • Fax: 814-726-9054
Mailing address:
  • Phone: 814-726-1420
  • Fax: 814-726-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number230402
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1015584350001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier315392
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC
# 3
Identifier00895212
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 4
Identifier238587
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHEALTH AMERICA
# 5
Identifier1523924
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGATEWAY HEALTH PLAN
# 6
Identifier92711
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerTHREE RIVERS HEALTH PLAN
# 7
Identifier0833
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK WESTERN PA

VIII. Authorized Official

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