MEDICARE: GGNSC MT. LEBANON LP

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	137202-PI	PA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0688	OTHER	PA	HIGHMARK WESTERN PA
2	000000079447	OTHER	PA	THREE RIVERS HEALTH PLAN
3	100274	OTHER	PA	HEALTH AMERICA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1506777	OTHER	PA	GATEWAY HEALTH PLAN
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	302053	OTHER	PA	UPMC

NPI Number	:	1851342232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GGNSC MT. LEBANON LP

Provider Business Mailing Address
First Line	:	350 OLD GILKESON RD
Second Line	:
City	:	MOUNT LEBANON
State	:	PA
Zip	:	15228-1063
Country	:	US
Telephone Number	:	412-257-4444
Fax Number	:	412-257-8226

Provider Business Practice Location Address
First Line	:	350 OLD GILKESON RD
Second Line	:
City	:	MOUNT LEBANON
State	:	PA
Zip	:	15228-1063
Country	:	US
Telephone Number	:	412-257-4444
Fax Number	:	412-257-8226

Authorized Official
Title or Position	:	SEC. OF THE GP
Name	:	HOLLY A. RASMUSSEN-JONES
Credential	:
Telephone Number	:	479-201-4835

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/16/2014

350 OLD GILKESON RD
MT LEBANON, PA
15228-1063

Practice Phone: 419-575-6685
Practice Fax: