NPIMap

Organization Active NPI

Unicare Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Fontana, CA
National Provider Identifier
1003373812
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UNICARE COMMUNITY HEALTH CENTER INC
Practice address
17500 Foothill Blvd Ste A2
Fontana, CA 92335-3798
Phone
(909) 428-0170
NPI assigned
Feb 28, 2019
Last updated
Mar 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Avetik Machkalyan
Title
Chief Executive Officer
Phone
(909) 988-2555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

17500 Foothill Blvd Ste A2
Fontana, CA 92335-3798

Mailing address

437 N Euclid Ave
Ontario, CA 91762-3456
Phone (909) 749-1835

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150623001589 CA Part B Supplier - Clinic/Group Practice 8426369067 Receives reassigned benefits from 141 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Colton, CA; Apple Valley, CA; San Bernardino, CA; Riverside, CA; Pomona, CA; Pacoima, CA; Ontario, CA; Los Angeles, CA…
O20190806003358 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426369067 Practice locations: Fontana, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003373812. Details of each certification follow.

Federally qualified health center certification: CCN 921180

Legal name
UNICARE COMMUNITY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 6, 2019
Last certification
Aug 6, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 6, 2002 in CA
Enrollment address
17500 Foothill Blvd
Ste A2
Fontana, CA 92335-3798

Other NPIs with the same Medicare PAC ID 17

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 17

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0855613Unicare Community Health Center, Inc17500 Foothill Blvd, Suite a-2, Fontana, CA 92335Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rosio Hobbs Individual Corporate DirectorBoard Secretary Jun 11, 2019
Abraham de Guzman Individual Corporate DirectorBoard Member Dec 4, 2019
Avetik Machkalyan Individual Corporate OfficerCeo May 1, 2019
W-2 Managing EmployeeCeo May 1, 2019
Sergio Martinez Individual Corporate DirectorBoard Member Mar 10, 2020
Alma R Enciso Individual Corporate DirectorBoard Treasurer May 1, 2019
Kassandra Sandoval Individual Corporate DirectorBoard Member Aug 10, 2020
Kelly H Vo Individual Corporate OfficerExecutive Vice President May 1, 2019
W-2 Managing EmployeeExecutive Vice President May 1, 2019
Yadira Contreras Individual Corporate DirectorBoard Member May 1, 2019
Nazeli Nercessian Individual Corporate DirectorBoard Member May 1, 2019
Vaghinak Vasilyan Individual Corporate DirectorBoard Member Jan 14, 2020
Michael Nolfsinger Individual Corporate DirectorBoard Member May 1, 2019
Martha Zuniga Individual Corporate DirectorBoard Secretary May 1, 2019

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1003373812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "437 N EUCLID AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917623456",
            "telephone_number": "909-749-1835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17500 FOOTHILL BLVD STE A2",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353798",
            "telephone_number": "909-428-0170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNICARE COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-28",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "MACHKALYAN",
        "authorized_official_first_name": "AVETIK",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "909-988-2555"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.