Healthcare Provider Details

I. General information

NPI: 1134798499
Provider Name (Legal Business Name): GRACE COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 W SYCAMORE ST
WILLIAMSBURG KY
40769-1739
US

IV. Provider business mailing address

1019 CUMBERLAND FALLS HWY STE B201
CORBIN KY
40701-2793
US

V. Phone/Fax

Practice location:
  • Phone: 606-400-6362
  • Fax: 606-526-8607
Mailing address:
  • Phone: 606-526-9005
  • Fax: 606-528-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DESTINEE DAMRON
Title or Position: MANAGER OF PAYER RELATIONS
Credential:
Phone: 606-526-9005