Provider Demographics
NPI:1669423992
Name:GGNSC CAMP HILL WEST SHORE LP
Entity type:Organization
Organization Name:GGNSC CAMP HILL WEST SHORE LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SEC. OF THE GP
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RASMUSSEN-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-201-4835
Mailing Address - Street 1:770 POPLAR CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2302
Mailing Address - Country:US
Mailing Address - Phone:717-763-7070
Mailing Address - Fax:717-763-7850
Practice Address - Street 1:770 POPLAR CHURCH RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2302
Practice Address - Country:US
Practice Address - Phone:717-763-7070
Practice Address - Fax:717-763-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA280202314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000119083OtherTHREE RIVERS HEALTH PLAN
PA1508302OtherGATEWAY HEALTH PLAN
PA2139OtherHIGHMARK CENTRAL FREEDOM
PA395223OtherCAPITAL BLUE CROSS
PA101553152Medicaid
PA1015531520001Medicaid
PA61360OtherGEISINGER HEALTH PLAN
CA395223Medicare Oscar/Certification
PA000000119083OtherTHREE RIVERS HEALTH PLAN