Healthcare Provider Details

I. General information

NPI: 1235566274
Provider Name (Legal Business Name): GRACE COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2013
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 RICHMOND RD
MANCHESTER KY
40962-1208
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 606-598-1810
  • Fax: 606-526-8606
Mailing address:
  • Phone: 606-526-9005
  • Fax: 606-526-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number700188
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number700188
License Number StateKY

VIII. Authorized Official

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