1326475369 NPI number — GRACE COMMUNITY HEALTH CENTER INC

Table of content: (NPI 1326475369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326475369 NPI number — GRACE COMMUNITY HEALTH CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE COMMUNITY HEALTH CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BIG CREEK ELEMENTARY SCHOOL BASED CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326475369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1019 CUMBERLAND FALLS HWY
Provider Second Line Business Mailing Address:
SUITE B201
Provider Business Mailing Address City Name:
CORBIN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40701-2735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-526-9005
Provider Business Mailing Address Fax Number:
606-526-8606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
523 N HIGHWAY 66
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONEIDA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40972-6607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-598-2812
Provider Business Practice Location Address Fax Number:
606-526-8606
Provider Enumeration Date:
10/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
STANLEY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
C.E.O.
Authorized Official Telephone Number:
606-526-9005

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  700188 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 700188 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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