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

Grace SBHC Middlesboro Middle School

Practice address

4400 W Cumberland Ave
Middlesboro, KY 40965-2626

Phone

(606) 242-8880

Fax

(606) 242-8885

NPI assigned

Nov 19, 2019

Last updated

Jun 28, 2024By 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

Chad Stevens

Title

Authorized Official

Phone

(606) 526-9005

Specialties & licenses 1

Addresses

Other names 1

• Grace SBHC Middlesboro Middle School 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 1265078885. Details of each certification follow.

• CCN 181175 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 181175

Legal name

GRACE COMMUNITY HEALTH CENTER, INC.

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 21, 2020

Last certification

Feb 21, 2020

Ownership / control type

For profit – partnership

Facility address

4400 W Cumberland Avenue
Middlesboro, KY 40965

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

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1265078885",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 W CUMBERLAND AVE",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409652626",
            "telephone_number": "606-242-8880",
            "fax_number": "606-242-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-19",
        "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": "Grace SBHC Middlesboro Middle School",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grace SBHC Middlesboro Middle School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deborah L. Gever, MD
• Kalynn Ray Gibson, APRN, CNP
• Stephanie Danielle Goins, APRN, PMHNP-BC,FNP-C
• Natasha Cornelius Good, PHARMD
• Grace Community Health Center Inc (Yellow Creek School Based Health Clinic)
• Grace Community Health Center, Inc. (Grace SBHC Middlesboro High School)
• Grace Community Health Center, Inc. (Grace SBHC Middlesboro Elementary School)
• Mikaela Lauren Gray, MA
• Melissa Crockett Gulley, PHARM D.
• H&H Family Chiropractic LLC

• 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.