Grace Community Health Center Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

GRACE COMMUNITY HEALTH CENTER INC

Doing business as

Central Elementary School Based Health Clinic

Practice address

1000 Ky 3439
Barbourville, KY 40906-7200

Phone

(606) 546-3496

NPI assigned

Dec 5, 2017

Last updated

Jun 28, 2024By the provider in NPPES

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

Chad Stevens

Title

Authorized Official

Phone

(606) 526-9005

Specialties & licenses 1

Addresses

Other names 1

• Central Elementary School Based Health Clinic Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104331719. Details of each certification follow.

• CCN 181075 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 181075

Legal name

CENTRAL ELEMENTARY SCHOOL BASED HEALTH CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 13, 2018

Last certification

Feb 13, 2018

Ownership / control type

For profit – corporation

Facility address

1000 Ky 3439
Barbourville, KY 40906

Part of

Grace Community Health Center

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew David Mountjoy, LPCC

  • Mental Health Counselor
  • Corbin, KY
  • NPI 1023359320
  NPD (past)

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

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1104331719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 CUMBERLAND FALLS HWY STE B201",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407012793",
            "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": "1000 KY 3439",
            "city": "BARBOURVILLE",
            "state": "KY",
            "postal_code": "409067200",
            "telephone_number": "606-546-3496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRACE COMMUNITY HEALTH CENTER INC",
        "enumeration_date": "2017-12-05",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "606-526-9005"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Elementary School Based Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gina Good, APRN
• Cynthia Goodin, APRN
• Grace Community Health Center Inc (Knox County Area Technology Center School Based Health Clinic)
• Grace Community Health Center Inc (Knox County Middle School Based Health Clinic)
• Grace Community Health Center Inc (G.R. Hampton Elementary School Based Health Clinic)
• Grace Community Health Center Inc (Knox Central High School Based Health Clinic)
• Grace Community Health Center Inc (Appalachian Children's Home School Based Health Clinic)
• Grace Community Health Center Inc (Jesse D. Lay Elementary School Based Health Clinic)
• Teresa Gray, APRN
• Thelma Jean Gray, APRN

• Federally Qualified Health Center (FQHC) in Barbourville, KY
• Providers in Barbourville, 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.