NPIMap

Organization Active NPI

Gracelight Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1013083666
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
960000219 Issued in CA
Legal business name
GRACELIGHT COMMUNITY HEALTH
Practice address
150 N Reno St
Los Angeles, CA 90026-4656
Phone
(213) 380-7298
Fax
(213) 385-1123
NPI assigned
Nov 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Authorized official

Name
Mrs. Eloisa Perard
Title
President & Ceo
Phone
(323) 669-4321

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 960000219 CA Primary

Addresses

Primary practice location

150 N Reno St
Los Angeles, CA 90026-4656

Mailing address

4816 E 3Rd St
Los Angeles, CA 90022-1602
Phone (323) 780-4510

Other names 1

  • Queenscare Health Centers Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100812001032 CA Part A Provider - Federally Qualified Health Center (FQHC) 3072619618 Practice locations: Los Angeles, CA
O20170425001131 CA Part B Supplier - Clinic/Group Practice 3072619618 Receives reassigned benefits from 73 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013083666. Details of each certification follow.

Federally qualified health center certification: CCN 551896

Legal name
GRACELIGHT COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 27, 2001
Last certification
Nov 27, 2001
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 8, 1982 in CA
Enrollment address
150N Reno St
Los Angeles, CA 90026-4656

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 4

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

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
05D0899572Gracelight Community Health150 N Reno St, Los Angeles, CA 90026Certificate of waiverApr 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Gracelight Community Health10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Jeff Hermann Individual Corporate DirectorBoard Chair Jul 31, 2017
Dennis Benton Individual W-2 Managing EmployeeChief Financial Officer Feb 18, 2020
Martha Arias Individual Corporate DirectorBoard Secretary Dec 28, 2015
Emma Nkwam Individual Corporate OfficerDirector of Risk and Compliance Apr 17, 2018
Mary E Ramos Individual Corporate Director Oct 1, 2010
Manuel J Romero Individual Corporate Director Nov 30, 2011
Jacquelyn P Pantoja Individual Corporate Director Jun 18, 2015
Allan P Michelena Individual Corporate Director Sep 21, 2001
Eloisa Perard Individual Corporate DirectorPresident & Chief Executive Officer Jun 26, 2017
Alexander Cornelius Lawrence Individual Corporate Director Jul 27, 2020
Queenscare Family Clinics/Queenscare Partnership Organization, Los Angeles, CA Corporation General Partnership Interest Jul 1, 2005
Victor S Aguilar Individual Corporate Director Jun 26, 2017
Aileen Hernandez Individual Corporate Director May 24, 2021
Harry B Kram Individual Corporate Director Jul 31, 2017
Serina Demirians Individual Corporate Director Feb 29, 2016
Ama Neel Individual Corporate Director May 22, 2020
Zoriy Elterman Individual Corporate Director Mar 29, 2021
Javier R Guerena Individual Corporate Director Jul 30, 2001
Carmen Andreasen Individual Corporate DirectorBoard Vice Chair Mar 30, 2020

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Gracelight Community HealthLos Angeles, CA, CCN 551895 Federally qualified health center Other Jul 1, 2009

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1013083666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4816 E 3RD ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900221602",
            "telephone_number": "323-780-4510",
            "fax_number": "323-981-1662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 N RENO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900264656",
            "telephone_number": "213-380-7298",
            "fax_number": "213-385-1123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACELIGHT COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "PERARD",
        "authorized_official_first_name": "ELOISA",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "323-669-4321",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "960000219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Queenscare Health Centers",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.