Grace Community Health Center Inc

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 Intermediate School Based Health Clinic

Practice address

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

Phone

(606) 528-1651

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

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

Addresses

Other names 1

• Corbin Intermediate School Based Health Clinic Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1912427675. Details of each certification follow.

• CCN 181049 Federally qualified health center · Active · Name & address match · Details
• CCN 181052 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 181049

Legal name

CORBIN INTERMEDIATE SCHOOL BASED HEALTH CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 13, 2017

Last certification

Sep 13, 2017

Ownership / control type

For profit – corporation

Facility address

404 17TH Street
Corbin, KY 40701

Federally qualified health center certification: CCN 181052

Legal name

CORBIN INTERMEDIATE SCHOOL BASED HEALTH CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 13, 2017

Last certification

Sep 13, 2017

Ownership / control type

For profit – corporation

Facility address

404 17TH St
Corbin, KY 40701

Part of

Grace Community Health Center Inc

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": "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": "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": "KY",
            "license": "700188",
            "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 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"
        }
    ]
}

• Grace Community Health Center Inc (Corbin Educational Center School Based Health Clinic)
• Grace Community Health Center Inc (Corbin Preschool School Based Health Clinic)
• Grace Community Health Center Inc (Corbin Primary School Based Health Clinic)
• Grace Community Health Center Inc
• Grace Community Health Center Inc
• 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. (Corbin Middle School Based Health Care)
• Grace Community Health Center, Inc.

• 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.