Healthcare Provider Details

I. General information

NPI: 1235486531
Provider Name (Legal Business Name): GRACE COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5923 HIGHWAY 80
WOOTON KY
41776-8840
US

IV. Provider business mailing address

5923 HWY 80
WOOTON KY
41776-0000
US

V. Phone/Fax

Practice location:
  • Phone: 606-526-9005
  • 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 Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number700188
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateKY

VIII. Authorized Official

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