MEDICARE: GGNSC EAST STROUDSBURG LP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	194002	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000130686	OTHER	PA	THREE RIVERS HEALTH PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	30984	OTHER	PA	GEISINGER HEALTH PLAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1526895	OTHER	PA	GATEWAY HEALTH PLAN

General Provider Information

NPI Number	:	1992756225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GGNSC EAST STROUDSBURG LP

Provider Business Mailing Address
First Line	:	221 E BROWN ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-3005
Country	:	US
Telephone Number	:	570-421-6200
Fax Number	:	570-421-6718

Provider Business Practice Location Address
First Line	:	221 E BROWN ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-3005
Country	:	US
Telephone Number	:	570-421-6200
Fax Number	:	570-421-6718

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

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Directions to “GGNSC EAST STROUDSBURG LP ” Practice Location

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