NPIMap

Organization Active NPI

Grace Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Manchester, KY
National Provider Identifier
1902048481
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.
Practice address
85 Highway 80
Manchester, KY 40962-8801
Phone
(606) 596-0410
Fax
(606) 596-0416
NPI assigned
Mar 31, 2009
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
Ceo
Phone
(606) 526-9005

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X 700188 KY Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

85 Highway 80
Manchester, KY 40962-8801

Mailing address

1019 Cumberland Falls Hwy
Suite B201
Corbin, KY 40734-4536
Phone (606) 526-9005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081211000571 KY Part B Supplier - Clinic/Group Practice 3870654064 Receives reassigned benefits from 90 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pineville, KY; Williamsburg, KY; Manchester, KY; London, KY; Hyden, KY; Corbin, KY; Booneville, KY
O20090708000531 KY Part A Provider - Federally Qualified Health Center (FQHC) 3870654064 Practice locations: Manchester, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902048481. Details of each certification follow.

Federally qualified health center certification: CCN 181873

Legal name
GRACE COMMUNITY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 12, 2009
Last certification
Aug 12, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 18, 2008 in KY
Enrollment address
85 Highway 80
Manchester, KY 40962-8801

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Grace Community Health Center

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Amy Russell Individual Corporate DirectorBoard Member Oct 31, 2018
Michael W Stanley Individual Corporate OfficerCeo Sep 17, 2012
W-2 Managing EmployeeCeo Sep 17, 2012
Roger West Individual Corporate DirectorBoard Member May 31, 2018
Damon Huff Individual Corporate DirectorBoard Member Mar 22, 2016
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 1, 2008
W-2 Managing EmployeeCfo Aug 1, 2008
Alesia R Anderson Individual W-2 Managing EmployeeDir of Oper MGR/Office MGR Aug 1, 2012
Operational/Managerial ControlDir of Oper MGR/Office MGR Oct 1, 2014
Hiram Cornett Individual Corporate DirectorBoard Member Dec 1, 2012
Angela G Singley Individual Corporate DirectorBoard Member Sep 15, 2015
James Garrison Individual Corporate DirectorBoard Member Dec 31, 2016
Melvin Scarberry Individual Corporate DirectorBoard Member Jan 1, 2010
Franklin Gray Individual Corporate DirectorBoard Member Jun 30, 2016
Loretta Lyttle Individual Corporate DirectorBoard Member Jun 30, 2016
Melinda J Bowling Individual Corporate DirectorBoard Member Jan 1, 2024

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1238457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1902048481",
    "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": "407344536",
            "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": "85 HIGHWAY 80",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409628801",
            "telephone_number": "606-596-0410",
            "fax_number": "606-596-0416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRACE COMMUNITY HEALTH CENTER INC",
        "enumeration_date": "2009-03-31",
        "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": "CEO",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "KY",
            "license": "700188",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, KY

Sources for this page

Verify at the official NPI Registry.