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

Corbin Middle School Based Health Care

Practice address

50 Ed McNeel Drive
Corbin, KY 40701

Phone

(606) 523-3619

Fax

(606) 523-3621

NPI assigned

Sep 12, 2018

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

Chief Financial Officer

Phone

(606) 526-9005

Specialties & licenses 4

Addresses

Other names 1

• Corbin Middle School Based Health Care 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 1770066136. Details of each certification follow.

• CCN 181088 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 181088

Legal name

CORBIN MIDDLE SCHOOL BASED HEALTH CARE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 24, 2018

Last certification

Oct 24, 2018

Ownership / control type

For profit – partnership

Facility address

50 Ed McNeel Drive
Corbin, KY 40701

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.

• Matthew David Mountjoy, LPCC

  • Mental Health Counselor
  • Corbin, KY
  • NPI 1023359320
  NPD (past)
• Callie Elizabeth Quillen, B.S. MHA

  • Professional Counselor
  • London, KY
  • NPI 1124501101
  NPD (past)

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

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1770066136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 CUMBERLAND FALLS HWY STE B210",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407012793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 ED MCNEEL DRIVE",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "40701",
            "telephone_number": "606-523-3619",
            "fax_number": "606-523-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-12",
        "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": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "606-526-9005"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corbin Middle School Based Health Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Corbin Middle School Based Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Grace Community Health Center Inc
• Grace Community Health Center Inc (Corbin Intermediate School Based Health Clinic)
• Grace Community Health Center, Inc. (Grace Health)
• Grace Community Health Center, Inc. (Grace Health Women's Care)
• Grace Community Health Center, Inc.
• Grace Community Health Center, Inc.
• Aimee Russell Grace, DO
• Nancy B Graham, MD
• Kasi Nicole Grande, BA
• Stephanie Hope Graves

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