Healthcare Provider Details

I. General information

NPI: 1174056261
Provider Name (Legal Business Name): GRACE COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
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

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

V. Phone/Fax

Practice location:
  • Phone: 606-528-2124
  • Fax: 606-528-8272
Mailing address:
  • Phone: 606-526-9005
  • Fax: 606-526-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W STANLEY
Title or Position: CEO
Credential:
Phone: 606-526-9005