Provider Demographics
NPI:1255319471
Name:GARRARD CONVALESCENT HOME SNF
Entity Type:Organization
Organization Name:GARRARD CONVALESCENT HOME SNF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:STACEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:859-581-9393
Mailing Address - Street 1:425 GARRARD ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2562
Mailing Address - Country:US
Mailing Address - Phone:859-581-9393
Mailing Address - Fax:859-291-2006
Practice Address - Street 1:425 GARRARD ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2562
Practice Address - Country:US
Practice Address - Phone:859-581-9393
Practice Address - Fax:859-291-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100266313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12500948Medicaid
KY1500955Medicaid
185038Medicare ID - Type Unspecified