South County Community Health Center, Inc.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.

Practice address

100 Terminal Ave
Menlo Park, CA 94025-1246

Phone

(650) 321-0980

Fax

(650) 321-0988

NPI assigned

Feb 27, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Wayne Yost, CPA, CFE

Title

Chief Financial Officer

Phone

(650) 330-7407

Specialties & licenses 1

Addresses

Other names 1

• Ravenswood Family Health Center at Belle Haven Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 051132

Legal name

RAVENSWOOD FAMILY HEALTH CENTER AT BELLE HAVEN

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

May 27, 2008

Last certification

May 27, 2008

Ownership / control type

For profit – corporation

Facility address

100 Terminal Avenue
Menlo Park, CA 94025

Locations

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222819200000",
    "number": "1073640918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1798 A BAY RD",
            "city": "EAST PALO ALTO",
            "state": "CA",
            "postal_code": "943031611",
            "telephone_number": "650-330-7400",
            "fax_number": "650-321-1560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 TERMINAL AVE",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940251246",
            "telephone_number": "650-321-0980",
            "fax_number": "650-321-0988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2008-10-01",
        "status": "A",
        "authorized_official_last_name": "YOST",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "650-330-7407",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA, CFE"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ravenswood Family Health Center at Belle Haven",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Taylor Jay Smith, LMFT
• Claudia Andrea Solis
• Lindsey Solomon, PT, DPT, CSCS
• Andrea Soto
• Soul Centric Empowerment Center
• Katie Marie Souza, ASW
• Speachy Learning Center
• Kaylin Spiteri, PT, DPT
• Scott Spivack, LMFT, LPCC
• Sprinter Medical East PC

• Primary Care Clinic/Center in Menlo Park, CA
• Providers in Menlo Park, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.