Healthcare Provider Details

I. General information

NPI: 1760909402
Provider Name (Legal Business Name): GRACE COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BISHOP ST
CORBIN KY
40701-1702
US

IV. Provider business mailing address

121 BISHOP ST
CORBIN KY
40701-1702
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-2124
  • Fax:
Mailing address:
  • Phone: 606-524-2124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07856
License Number StateKY

VIII. Authorized Official

Name: REBECCA CHEEK
Title or Position: CLINICAL PHARMACIST
Credential: PHARMD
Phone: 606-526-9005