GC Home Holdings, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100266 Issued in KY

Legal business name

GC HOME HOLDINGS, LLC

Doing business as

Providence Pavilion

Practice address

401 E 20TH St
Covington, KY 41014-1583

Phone

(859) 283-6600

NPI assigned

Mar 18, 2009

Last updated

Jan 22, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. George S Hagan IV

Title

Manager

Phone

(859) 261-5231

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Providence Pavilion Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264118400000",
    "number": "1639310881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4322 ALEXANDRIA PIKE",
            "city": "COLD SPRING",
            "state": "KY",
            "postal_code": "410761918",
            "telephone_number": "859-261-5231",
            "fax_number": "859-261-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E 20TH ST",
            "city": "COVINGTON",
            "state": "KY",
            "postal_code": "410141583",
            "telephone_number": "859-283-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GC HOME HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-18",
        "last_updated": "2010-01-22",
        "status": "A",
        "authorized_official_last_name": "HAGAN",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "859-261-5231",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "IV"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "KY",
            "license": "100266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "185038",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100081080",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Pavilion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Covington, KY
• Providers in Covington, KY by specialty
• Skilled Nursing Facility in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.