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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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