NPIMap

Organization Active NPI

Family Health Care Associates 11 Limited Liability Company

  • Rural Health Clinic/Center
  • London, KY
National Provider Identifier
1831881887
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAMILY HEALTH CARE ASSOCIATES 11 LIMITED LIABILITY COMPANY
Practice address
804 W Laurel Rd
London, KY 40741-8209
Phone
(606) 770-5026
Fax
(606) 645-1776
NPI assigned
May 25, 2023
Last updated
Jul 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gina Good, APRNNPI 1831167584
Title
Owner
Phone
(606) 546-7777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

804 W Laurel Rd
London, KY 40741-8209

Mailing address

PO Box 1535
Barbourville, KY 40906-5535

Other practice location 1

203 Van House Lane Ste 1
London, KY 40741
Phone (606) 546-7777

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230825003333 KY Part A Provider - Rural Health Clinic 9931562717 Practice locations: London, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831881887. Details of each certification follow.

Rural health clinic certification: CCN B03952

Legal name
FAMILY HEALTH CARE ASSOCIATES 11 LIMITED LIABILITY COMPANY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 28, 2023
Last certification
Dec 28, 2023
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
May 11, 2023 in KY
Enrollment address
804 W Laurel Rd
London, KY 40741-8209

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
18D2282688Family Health Care Associates 11, LLC804 W Laurel Rd, London, KY 40741Certificate of waiverMay 23, 2027

National Provider Directory

National Provider Directory

Locations

203 Van House Ln
Ste 1
London, KY 40741
Phone (606) 595-9005

804 W Laurel Rd
London, KY 40741
Phone (606) 770-5026

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gina Good Individual General Partnership InterestDeo May 11, 2023
W-2 Managing EmployeeCeo May 11, 2023
Donevon Storms Individual General Partnership InterestPartner/Member May 11, 2023
Kevin Buchanan Individual General Partnership Interest May 11, 2023 40%
Maria Storms Individual General Partnership InterestPartner/Member May 11, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Gina Good, APRN
    • Family Nurse Practitioner
    • Barbourville, KY
    • NPI 1831167584

    General Partnership Interest, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1684972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752624000000",
    "number": "1831881887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1535",
            "city": "BARBOURVILLE",
            "state": "KY",
            "postal_code": "409065535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 W LAUREL RD",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407418209",
            "telephone_number": "606-770-5026",
            "fax_number": "606-645-1776"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "203 VAN HOUSE LANE STE 1",
            "address_purpose": "LOCATION",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "40741",
            "country_code": "US",
            "telephone_number": "606-546-7777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAMILY HEALTH CARE ASSOCIATES 11 LIMITED LIABILITY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-25",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A",
        "authorized_official_last_name": "GOOD",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-546-7777",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in London, KY

Sources for this page

Verify at the official NPI Registry.