1902048481 NPI number — GRACE COMMUNITY HEALTH CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902048481 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:
Provider Other Organization Name Type Code:
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:
1902048481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2018
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:
40734-4536
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:
85 HIGHWAY 80
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40962-8801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-596-0410
Provider Business Practice Location Address Fax Number:
606-596-0416
Provider Enumeration Date:
03/31/2009

Additional Information

			
		

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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