Provider Demographics
NPI:1134798499
Name:GRACE COMMUNITY HEALTH CENTER, INC.
Entity type:Organization
Organization Name:GRACE COMMUNITY HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DESTINEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-526-9005
Mailing Address - Street 1:1019 CUMBERLAND FALLS HWY STE B201
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2793
Mailing Address - Country:US
Mailing Address - Phone:606-526-9005
Mailing Address - Fax:606-528-3871
Practice Address - Street 1:49 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1739
Practice Address - Country:US
Practice Address - Phone:606-400-6362
Practice Address - Fax:606-526-8607
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE COMMUNITY HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-22
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)