NPIMap

Organization Active NPI

Grace Community Health Center, Inc.

Doing business as Grace SBHC Middlesboro High School

  • Federally Qualified Health Center (FQHC)
  • Middlesboro, KY
National Provider Identifier
1356987978
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GRACE COMMUNITY HEALTH CENTER, INC.
Doing business as
Grace SBHC Middlesboro High School
Practice address
4404 W Cumberland Ave
Middlesboro, KY 40965-2626
Phone
(606) 242-8820
Fax
(606) 242-8825
NPI assigned
Nov 19, 2019
Last updated
Jun 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

4404 W Cumberland Ave
Middlesboro, KY 40965-2626

Mailing address

1019 Cumberland Falls Hwy Ste B201
Corbin, KY 40701-2793

Other names 1

  • Grace SBHC Middlesboro High School Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200225000721 KY Part A Provider - Federally Qualified Health Center (FQHC) 3870654064 Practice locations: Middlesboro, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356987978. Details of each certification follow.

Federally qualified health center certification: CCN 181176

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
Organization structure
CorporationNon-profit
Incorporated
Jan 18, 2008 in KY
Enrollment address
4404 W Cumberland Ave
Middlesboro, KY 40965-2626

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

4404 W Cumberland Ave
Middlesboro, KY 40965
Phone (606) 242-2451

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Michael W Stanley Individual Corporate OfficerCeo Aug 13, 2018
W-2 Managing EmployeeCeo Aug 13, 2018
Karen a Hubbs Individual Corporate DirectorBoard Member Mar 22, 2016
Jeff W Hamlin Individual Corporate DirectorBoard Member May 1, 2012
Chad Stevens Individual Corporate OfficerCfo Aug 13, 2018
Hiram Cornett Individual Corporate DirectorBoard Member Dec 1, 2012
Melinda J Bowling Individual 5% Or Greater Direct Ownership Interest Jan 1, 2024 5%

NPI Registry JSON

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": "1356987978",
    "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": "4404 W CUMBERLAND AVE",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409652626",
            "telephone_number": "606-242-8820",
            "fax_number": "606-242-8825"
        }
    ],
    "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 High School",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grace SBHC Middlesboro High School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Middlesboro, KY

Sources for this page

Verify at the official NPI Registry.