# GC HOME HOLDINGS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Pavilion
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639310881
- **Authorized official:** MR. GEORGE S HAGAN IV (MANAGER)
- **Authorized official phone:** (859) 261-5231

## Contact information

- **Practice address:** 401 E 20TH ST, COVINGTON, KY 41014-1583
- **Practice address phone:** (859) 283-6600
- **Mailing address:** 4322 ALEXANDRIA PIKE, COLD SPRING, KY 41076-1918
- **Mailing address phone:** (859) 261-5231
- **Mailing address fax:** (859) 261-1008

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 100266 | KY | Yes |

## Other

- **Enumeration date:** 03/18/2009
- **Last updated:** 01/22/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 185038 | MEDICARE PROVIDER NUMBER | KY |
| 05 | — | 7100081080 | — | KY |