NPIMap

Organization Active NPI

Friends of Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Ontario, CA
National Provider Identifier
1003546342
Registry record updated Jun 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FRIENDS OF FAMILY HEALTH CENTER
Practice address
1129 W 4TH St
Ontario, CA 91762-1703
Phone
(909) 363-9300
Fax
(562) 690-3182
NPI assigned
Jun 10, 2022
Last updated
Jun 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2022

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

Authorized official

Name
Nicolis Arias
Title
Credentialing
Phone
(562) 690-0400

Specialties & licenses 1

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

Addresses

Primary practice location

1129 W 4TH St
Ontario, CA 91762-1703

Mailing address

501 S Idaho St Ste 100
La Habra, CA 90631-6047
Phone (562) 690-0400

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110323000139 CA Part B Supplier - Clinic/Group Practice 7315120730 Receives reassigned benefits from 18 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: La Habra, CA; Whittier, CA; Tustin, CA; Ontario, CA; La Puente, CA; Pico Rivera, CA
O20220127002838 CA Part A Provider - Federally Qualified Health Center (FQHC) 7315120730 1 other NPI on this enrollment
Practice locations: Ontario, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003546342. Details of each certification follow.

Federally qualified health center certification: CCN A01043

Legal name
FRIENDS OF FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 27, 2022
Last certification
Jan 27, 2022
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
1129 W 4TH St
Ontario, CA 91762-1703

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Friends of Family Health Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

501 S Idaho St
#1000
La Habra, CA 90631

501 S Idaho St
Ste 1
La Habra, CA 90631

501 S Idaho St
Ste 140
La Habra, CA 90631

501 S Idaho St
Ste 250
La Habra, CA 90631
Phone (560) 690-0400

565 S Azusa Way
La Puente, CA 91744
Phone (626) 913-4795

333 Corporate Dr
Ste 200
Ladera Ranch, CA 92694
Phone (949) 347-7200

24422 Avenida de la Carlota
Ste 300
Laguna Hills, CA 92653
Phone (949) 599-2434

1788 Sierra Leone Ave
Ste 105
Rowland Heights, CA 91748
Phone (626) 965-0150

33 W Thousand Oaks Blvd
Ste A2
Thousand Oaks, CA 91360
Phone (805) 497-7888

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
Kathleen Sauble Individual 5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%
Maida I Valencia Individual Operational/Managerial ControlDirector of Revenue Cycle Oct 1, 2021
David Deleon Individual 5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%
Mojgan Manshadi Individual 5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%
Salvador H. Cervantes Individual 5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%
Amanda Aviles Individual Corporate DirectorBoard Member Feb 13, 2025 100%
Sherleen Thao Le Individual Corporate DirectorBoard Member Feb 13, 2025 100%
Dung Ngoc Tran Individual Corporate OfficerCfo Oct 1, 2021
Elizabeth Walker Individual 5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%
Tyson Shih Individual 5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%
Bahram Bahremand Individual Corporate OfficerCeo Jan 3, 2022 100%
Robert C. Gire Individual 5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Tyson Shih, MD
    • Otolaryngology Physician
    • Pomona, CA
    • NPI 1932181138

    5% Or Greater Direct Ownership Interest, Corporate Director

    CMS ownership

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Friends of Family Health CenterLa Habra, CA, CCN 751018 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2010
Friends of Family Health CenterTustin, CA, CCN 751818 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2010

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1654819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654819200000",
    "number": "1003546342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S IDAHO ST STE 100",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906316047",
            "telephone_number": "562-690-0400",
            "fax_number": "562-690-3182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 W 4TH ST",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917621703",
            "telephone_number": "909-363-9300",
            "fax_number": "562-690-3182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRIENDS OF FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-10",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A",
        "authorized_official_last_name": "ARIAS",
        "authorized_official_first_name": "NICOLIS",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "562-690-0400"
    },
    "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 Ontario, CA

Sources for this page

Verify at the official NPI Registry.