Healthcare Provider Details

I. General information

NPI: 1629508296
Provider Name (Legal Business Name): GRACE COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 CUMBERLAND FALLS HIGHWAY
CORBIN KY
40740-2722
US

IV. Provider business mailing address

1019 CUMBERLAND FALLS HWY SUITE B201
CORBIN KY
40701-2735
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-4481
  • Fax: 606-528-6531
Mailing address:
  • Phone: 606-526-9005
  • Fax: 606-526-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W. STANLEY
Title or Position: C.E.O.
Credential:
Phone: 606-526-9005