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Organization
GC HOME HOLDINGS, LLC
Active
Organization
GC HOME HOLDINGS, LLC
Active
Other names
Providence Pavilion
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE S HAGAN IV (MANAGER)
(859) 261-5231
Entity
Organization
Contact information
Practice address
401 E 20TH ST, COVINGTON, KY 41014-1583
(859) 283-6600
Mailing address
4322 ALEXANDRIA PIKE, COLD SPRING, KY 41076-1918
(859) 261-5231
(859) 261-1008
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100266
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
185038
MEDICARE PROVIDER NUMBER
KY
05
—
7100081080
—
KY
Enumeration date
03/18/2009
Last updated
01/22/2010
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