Grace Community Health Center Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

700188 Issued in KY

Legal business name

GRACE COMMUNITY HEALTH CENTER INC

Practice address

4840 W. Cumberland Avenue
Middlesboro, KY 40965-9078

Phone

(606) 248-1293

Fax

(606) 526-8606

NPI assigned

Jun 6, 2017

Organization subpart

Yes

Parent organization

GRACE COMMUNITY HEALTH CENTER INCAs reported in NPPES

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

Authorized official

Name

Michael W. Stanley

Title

C.E.O.

Phone

(606) 526-9005

Specialties & licenses 4

Addresses

Other names 1

• Yellow Creek School Based Health Clinic Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 181032

Legal name

YELLOW CREEK SCHOOL BASED HEALTH CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 18, 2017

Last certification

Aug 18, 2017

Ownership / control type

For profit – corporation

Facility address

4840 W Cumberland Ave
Middlesboro, KY 40965

Part of

Grace Health Pharmacy-Manchester

Locations

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1083143994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 CUMBERLAND FALLS HWY",
            "address_2": "SUITE B201",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407012735",
            "telephone_number": "606-526-9005",
            "fax_number": "606-526-8606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 W. CUMBERLAND AVENUE",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409659078",
            "telephone_number": "606-248-1293",
            "fax_number": "606-526-8606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRACE COMMUNITY HEALTH CENTER INC",
        "enumeration_date": "2017-06-06",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "STANLEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "606-526-9005"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "KY",
            "license": "700188",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yellow Creek School Based Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Yellow Creek School Based Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ethan Blake Gambrel, PT, DPT
• Michelle A Garrett, O.D.
• Deborah L. Gever, MD
• Stephanie Danielle Goins, APRN, PMHNP-BC,FNP-C
• Natasha Cornelius Good, PHARMD
• Grace Community Health Center, Inc.
• Grace Community Health Center, Inc.
• Grace Community Health Center, Inc.
• Mikaela Lauren Gray, MA
• Melissa Crockett Gulley, PHARM D.

• Federally Qualified Health Center (FQHC) in Middlesboro, KY
• Providers in Middlesboro, KY by specialty
• Federally Qualified Health Center (FQHC) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.