Healthcare Provider Details

I. General information

NPI: 1639310881
Provider Name (Legal Business Name): GC HOME HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 20TH ST
COVINGTON KY
41014-1583
US

IV. Provider business mailing address

4322 ALEXANDRIA PIKE
COLD SPRING KY
41076-1918
US

V. Phone/Fax

Practice location:
  • Phone: 859-283-6600
  • Fax:
Mailing address:
  • Phone: 859-261-5231
  • Fax: 859-261-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100266
License Number StateKY

VIII. Authorized Official

Name: MR. GEORGE S HAGAN IV
Title or Position: MANAGER
Credential:
Phone: 859-261-5231