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

Leslie County High School

Practice address

25 Eagle Lane
Hyden, KY 41749

Phone

(606) 672-2337

NPI assigned

Jun 14, 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

Ao

Phone

(606) 526-9005

Specialties & licenses 1

Addresses

Other names 1

• Leslie County High 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 1679133391. Details of each certification follow.

• CCN 181189 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 181189

Legal name

LESLIE COUNTY HIGH SCHOOL

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jan 29, 2020

Last certification

Jan 29, 2020

Ownership / control type

For profit – partnership

Facility address

25 Eagle Lane
Hyden, KY 41749

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

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1679133391",
    "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": "606-672-2337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 EAGLE LANE",
            "city": "HYDEN",
            "state": "KY",
            "postal_code": "41749",
            "telephone_number": "606-672-2337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-14",
        "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": "AO",
        "authorized_official_telephone_number": "606-526-9005"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Leslie County High School",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Leslie County High School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Keirstian Fultz
• Lindsay Gay, SLP
• Carlenia Irene Gose, COTA/L
• Grace Community Health Center Inc (Mountain View Elementary School Based Health Clinic)
• Grace Community Health Center Inc (Hyden Clinic)
• Tracey Angela Grigsby, MS, RD, LDN
• Marjorie Haas, M.D.
• Jessica Laise Hacker, PHARMD
• Nora C Hamlin, ARNP
• Donald I Holbrook, OD

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