NPIMap

Organization Active NPI

Behavioral Health Services Inc.

Doing business as BHS - El Puerto Family Health Center

  • Community Health Clinic/Center
  • Wilmington, CA
National Provider Identifier
1023536992
Registry record updated Aug 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
550003493 Issued in CA
Legal business name
BEHAVIORAL HEALTH SERVICES INC.
Doing business as
BHS - El Puerto Family Health Center
Practice address
1334 N Avalon Blvd
Wilmington, CA 90744-2639
Phone
(310) 835-4009
Fax
(310) 679-2920
NPI assigned
Aug 31, 2017
Last updated
Aug 31, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2017

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

Authorized official

Name
Ms. Shirley Ann Summers, LCSWNPI 1467891655
Title
President/Chief Executive Officer
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
Community Health Clinic/Center 261QC1500X 550003493 CA Primary

Addresses

Primary practice location

1334 N Avalon Blvd
Wilmington, CA 90744-2639

Mailing address

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

Other names 1

  • BHS - El Puerto Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180717000681 CA Part A Provider - Federally Qualified Health Center (FQHC) 8729142146 Practice locations: Wilmington, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023536992. Details of each certification follow.

Federally qualified health center certification: CCN 921971

Legal name
BEHAVIORAL HEALTH SERVICES INC.
Doing business as
BHS-EL PUERTO HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 15, 2021
Last certification
Jun 15, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 13, 1973 in CA
Enrollment address
1334 N Avalon Blvd
Wilmington, CA 90744-2639

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

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
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 Financial institution 5% Or Greater Mortgage Interest Sep 6, 2017 35%
Michael John Ballue Individual Corporate Officer Apr 1, 2008
W-2 Managing Employee Apr 1, 2008
Victoria Velarde Individual Corporate DirectorBoard Chairperson Apr 30, 1998
David Gascon Individual Corporate DirectorDirector Jan 29, 2009
Ernesto Saucedo Individual Corporate DirectorDirector Jan 25, 2015
Joe Gatlin Individual Corporate DirectorDirector Aug 25, 2016
James King Individual Corporate DirectorBoard Secretary Aug 25, 2016
Iris Duran Individual Corporate DirectorDirector Jun 27, 2019
Deborah Levan Individual Corporate DirectorDirector Oct 16, 2017
Shirley Summers Individual Corporate OfficerPresident/Ceo 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 1

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": "1504137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504137600000",
    "number": "1023536992",
    "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": "1334 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907442639",
            "telephone_number": "310-835-4009",
            "fax_number": "310-679-2920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL HEALTH SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-31",
        "last_updated": "2017-08-31",
        "status": "A",
        "authorized_official_last_name": "SUMMERS",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT/CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "310-679-9126",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "550003493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BHS - El Puerto Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, CA

Sources for this page

Verify at the official NPI Registry.