NPIMap

Organization Active NPI

Grace Community Health Center Inc

Doing business as Corbin Primary School Based Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Corbin, KY
National Provider Identifier
1730609496
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
700188 Issued in KY
Legal business name
GRACE COMMUNITY HEALTH CENTER INC
Doing business as
Corbin Primary School Based Health Clinic
Practice address
3551 5TH Street Rd
Corbin, KY 40701-9650
Phone
(606) 595-8631
Fax
(606) 526-8606
NPI assigned
Jun 23, 2017
Last updated
Jun 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GRACE COMMUNITY HEALTH CENTER INCAs reported in NPPES

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
Michael W. Stanley
Title
C.E.O.
Phone
(606) 526-9005

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 700188 KY Primary
Family Nurse Practitioner 363LF0000X
Psychologist 103T00000X
Clinical Psychologist 103TC0700X

Addresses

Primary practice location

3551 5TH Street Rd
Corbin, KY 40701-9650

Mailing address

1019 Cumberland Falls Hwy
Suite B201
Corbin, KY 40701-2735
Phone (606) 526-9005

Other names 1

  • Corbin Primary School Based Health Clinic Doing business as

Medicare participation

Medicare enrollment files
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 1730609496. Details of each certification follow.

  • CCN 181027 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 181027

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CORBIN PRIMARY SCHOOL CASED HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 8, 2017
Last certification
Aug 8, 2017
Ownership / control type
For profit – corporation
Facility address
3551 5TH Street Rd
Corbin, KY 40701

National Provider Directory

National Provider Directory
Part of
Grace Health Pharmacy-Manchester

Practitioners & affiliated clinicians

Practitioners 2

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": "1498176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1730609496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 CUMBERLAND FALLS HWY",
            "address_2": "SUITE B201",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407012735",
            "telephone_number": "606-526-9005",
            "fax_number": "606-526-8606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 5TH STREET RD",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407019650",
            "telephone_number": "606-595-8631",
            "fax_number": "606-526-8606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRACE COMMUNITY HEALTH CENTER INC",
        "enumeration_date": "2017-06-23",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "STANLEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "606-526-9005"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "KY",
            "license": "700188",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corbin Primary School Based Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Corbin Primary School Based Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Corbin, KY

Sources for this page

Verify at the official NPI Registry.