Healthcare Provider Details

I. General information

NPI: 1255319471
Provider Name (Legal Business Name): GARRARD CONVALESCENT HOME SNF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 GARRARD ST
COVINGTON KY
41011-2562
US

IV. Provider business mailing address

425 GARRARD ST
COVINGTON KY
41011-2562
US

V. Phone/Fax

Practice location:
  • Phone: 859-581-9393
  • Fax: 859-291-2006
Mailing address:
  • Phone: 859-581-9393
  • Fax: 859-291-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100266
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number100266
License Number StateKY

VIII. Authorized Official

Name: MR. RALPH L. STACEY JR.
Title or Position: PRESIDENT
Credential:
Phone: 859-581-9393