NPIMap

Organization Active NPI

Grace Community Health Center, Inc.

Doing business as Grace Health Mountain View Clinic

  • Federally Qualified Health Center (FQHC)
  • London, KY
National Provider Identifier
1548818537
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 Health Mountain View Clinic
Practice address
272 London Mountain View Dr
London, KY 40741-6601
Phone
(606) 877-2850
Fax
(606) 877-2857
NPI assigned
Sep 3, 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

272 London Mountain View Dr
London, KY 40741-6601

Mailing address

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

Other names 1

  • Grace Health Mountain View Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200108002037 KY Part A Provider - Federally Qualified Health Center (FQHC) 3870654064 Practice locations: London, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548818537. Details of each certification follow.

Federally qualified health center certification: CCN 181168

Legal name
GRACE COMMUNITY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 7, 2020
Last certification
Jan 7, 2020
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 18, 2008 in KY
Enrollment address
272 London Mountain View Dr
London, KY 40741-6601

Other NPIs with the same Medicare PAC ID 9

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D1049064Grace Health Mountain View Clinic272 London Mountain View, London, KY 40741Provider-performed microscopyDec 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Grace Community Health Center Inc20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

313 S Cherry St
Pineville, KY 40977
Phone (606) 654-3338

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%

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1567468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1548818537",
    "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": "272 LONDON MOUNTAIN VIEW DR",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407416601",
            "telephone_number": "606-877-2850",
            "fax_number": "606-877-2857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-03",
        "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 Health Mountain View Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grace Health Mountain View Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in London, KY

Sources for this page

Verify at the official NPI Registry.