Grace Community Health Center Inc

Key facts

NPI

1912427675

Entity type

Organization (NPI type 2)

Primary specialty

Federally Qualified Health Center (FQHC) 261QF0400X

License

700188 (KY)

Legal business name

GRACE COMMUNITY HEALTH CENTER INC

Practice address

404 W. 17TH Street
Corbin, KY 40701-1922

Phone

(606) 528-1651

Fax

(606) 526-8606

NPI assigned

Jun 23, 2017

Organization subpart

Yes

Parent organization (as reported)

GRACE COMMUNITY HEALTH CENTER INC

Authorized official

Name

Michael W. Stanley

Title

C.E.O.

Phone

(606) 526-9005

National Provider Directory

Part of

Grace Health Pharmacy-Manchester

Specialties & licenses

Addresses

Other names

• Corbin Intermediate School Based Health Clinic Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 28, 2024.

{
    "created_epoch": "1498176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1912427675",
    "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": "404 W. 17TH STREET",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407011922",
            "telephone_number": "606-528-1651",
            "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": "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": "KY",
            "license": "700188",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "700188",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corbin Intermediate School Based Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Corbin Intermediate School Based Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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