NPIMap

Organization Active NPI

Behavioral Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hawthorne, CA
National Provider Identifier
1013528108
Registry record updated Aug 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BEHAVIORAL HEALTH SERVICES, INC.
Practice address
12954 Hawthorne Blvd Ste 100
Hawthorne, CA 90250-4418
Phone
(310) 978-6900
Fax
(310) 218-5484
NPI assigned
Aug 12, 2020
Last updated
Aug 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2020

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

Authorized official

Name
Ms. Shirley Summers, LCSWNPI 1467891655
Title
President/Ceo
Phone
(310) 679-9126

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

12954 Hawthorne Blvd Ste 100
Hawthorne, CA 90250-4418

Mailing address

15519 Crenshaw Blvd
Gardena, CA 90249-4525
Phone (310) 679-9126

Other names 1

  • BHS - Health Center for Women Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220727003278 CA Part A Provider - Federally Qualified Health Center (FQHC) 8729142146 Practice locations: Hawthorne, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013528108. Details of each certification follow.

Federally qualified health center certification: CCN A01093

Legal name
BEHAVIORAL HEALTH SERVICES INC.
Doing business as
BHS HEALTH CENTER FOR WOMEN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 27, 2022
Last certification
Jul 27, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 13, 1973 in CA
Enrollment address
12954 Hawthorne Blvd
Ste 100
Hawthorne, CA 90250-4418

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Behavioral Health Services41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

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

View all 40

Locations

1000 E Dominguez St
Ste 110
Carson, CA 90746
Phone (310) 715-7755

12954 Hawthorne Blvd
Ste 100
Hawthorne, CA 90250
Phone (310) 978-6900

4511 Whittier Blvd
Los Angeles, CA 90022
Phone (323) 264-2890

6838 W Sunset Blvd
Los Angeles, CA 90028
Phone (323) 461-3161

2015 W 1st St
Ste L
Santa Ana, CA 92703
Phone (714) 716-1830

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Theresa Cannon Individual Corporate DirectorBoard- Vice Chairperson Jan 25, 2014
Rick Lam Individual Corporate DirectorBoard Treasurer Aug 27, 2020
First Citizens Bank & Trust Company Organization, Encino, CA Corporation, Financial institution 5% Or Greater Mortgage Interest Oct 16, 2017 35%
Michael John Ballue Individual W-2 Managing Employee Apr 1, 2008
David Gascon Individual Corporate Director Jan 29, 2009
Ernesto Saucedo Individual Corporate Director Jan 25, 2015
Joe Gatlin Individual Corporate Director Aug 25, 2016
Todd Turley Individual Corporate OfficerTodd Turley Nov 17, 2011
James King Individual Corporate DirectorBoard Secretary Aug 25, 2016
Iris Duran Individual Corporate Director Jun 27, 2019
Shirley Summers Individual Corporate OfficerChief Executive Officer Aug 1, 2014

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
Behavioral Health Services - Family Health CenterHawthorne, CA, CCN 751903 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 13, 1973

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 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597190400000",
    "number": "1013528108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15519 CRENSHAW BLVD",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902494525",
            "telephone_number": "310-679-9126",
            "fax_number": "310-679-2920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12954 HAWTHORNE BLVD STE 100",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902504418",
            "telephone_number": "310-978-6900",
            "fax_number": "310-218-5484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-12",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A",
        "authorized_official_last_name": "SUMMERS",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "310-679-9126",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BHS - Health Center for Women",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hawthorne, CA

Sources for this page

Verify at the official NPI Registry.