Grace Community Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Middlesboro, KY
NPI 1356987978 · NPPES record last updated Jun 28, 2024
Key facts
- NPI
- 1356987978
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- GRACE COMMUNITY HEALTH CENTER, INC.
- Practice address
- 4404 W Cumberland Ave
Middlesboro, KY 40965-2626 - Phone
- (606) 242-8820
- Fax
- (606) 242-8825
- NPI assigned
- Nov 19, 2019
- Organization subpart
- No
Authorized official
- Name
- Chad Stevens
- Title
- Authorized Official
- Phone
- (606) 526-9005
Other NPIs with the same Medicare PAC ID 9
Practitioners 65
-
Hilary Baker, LPCC
-
Morgan Whitney Birch, D.O.
-
Kevin Brooks, PA
-
Wendy Dawn Brown, APRN
-
Amanda Irene Collett, FNP-BC
-
Lyndsay Collette, PA-C
-
Kassidy Michaela Creech, LCSW
-
Jody Robyn Deltoro, APRN
-
William R Durham, MD
-
Kelly Evans, D.O.
-
Angela Eversole, APRN
-
Shawn Shadell Fugate, M.D.
-
Carolyn Onlee Gaines, LPCC
-
Stacie Leigh Green, APRN
-
Brittany Nicole Grega, PA-C
-
Theresa Gross, APRN
-
Sarah Hall, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
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
- Corporation · Non-profit
- Incorporated
- Jan 18, 2008 in KY
- Enrollment address
- 4404 W Cumberland Ave
Middlesboro, KY 40965-2626
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Michael W Stanley |
Corporate Officer |
Aug 13, 2018 | |
| W-2 Managing Employee |
Aug 13, 2018 | ||
| Karen a Hubbs |
Corporate Director |
Mar 22, 2016 | |
| Jeff W Hamlin |
Corporate Director |
May 1, 2012 | |
| Chad Stevens |
Corporate Officer |
Aug 13, 2018 | |
| Hiram Cornett |
Corporate Director |
Dec 1, 2012 | |
| Melinda J Bowling |
5% Or Greater Direct Ownership Interest | Jan 1, 2024 | 5% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200225000721 | KY | Part a Provider - Federally Qualified Health Center (FQHC) | 3870654064 | Practice locations: Middlesboro, KY |
National Provider Directory
Locations
4404 W Cumberland Ave
Middlesboro, KY 40965
Phone (606) 242-2451
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
- Grace SBHC Middlesboro High School
Other providers in Middlesboro, KY
- Deborah L. Gever
- Stephanie Danielle Goins
- Natasha Cornelius Good
- Grace Community Health Center Inc
- Grace Community Health Center, Inc.
- Grace Community Health Center, Inc.
- Mikaela Lauren Gray
- Melissa Crockett Gulley
- H&H Family Chiropractic LLC
- Jordyn D Hale
All providers in Middlesboro, KY · Federally Qualified Health Center (FQHC) in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.