Altamed Health Services Corp
Organization Active NPI Community Health Clinic/Center · Garden Grove, CA
NPI 1083851992 · NPPES record last updated Aug 13, 2019
Key facts
- NPI
- 1083851992
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- Legal business name
- ALTAMED HEALTH SERVICES CORP
- Practice address
- 12751 Harbor Blvd
Garden Grove, CA 92840-5800 - Phone
- (714) 636-7852
- Fax
- (714) 636-0928
- NPI assigned
- Jan 14, 2009
- Organization subpart
- No
Authorized official
- Name
- Robert U. Young, M.D.
- Title
- VP, Patient Financial Services
- Phone
- (323) 622-2429
Owners & managing parties with NPI records 1
-
Jose Avalos, M.D.
Other NPIs with the same Medicare PAC ID 22
Corporate family (same tax ID) 24
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D1106763 | Altamed Medical Group-Garden Grove Harbor | Certificate of waiver | Oct 20, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Federally qualified health center certification: CCN 551025
- Legal name
- ALTAMED HEALTH SERVICES CORP
- Doing business as
- ALTAMED MEDICAL GROUP-GARDEN GROVE, HARBOR
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 16, 2010
- Last certification
- Apr 16, 2010
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 21, 1970 in CA
- Enrollment address
- 12751 Harbor Blvd
Garden Grove, CA 92840-5800
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Maria Grimaldo |
Corporate Director |
Oct 29, 2013 | |
| Jose Avalos |
Corporate Director |
Jun 28, 2018 | |
| Adolfo O Chanez |
Corporate Director |
Feb 25, 2016 | |
| Castulo de la Rocha |
Corporate Officer |
Mar 1, 1997 | |
| Marc Victor |
Corporate Director |
Oct 26, 2017 | |
| Ricardo Robles |
Corporate Director |
Jan 22, 2015 | |
| Victor Olmos |
Corporate Director |
Oct 23, 2020 | |
| Joseph Gomez |
Corporate Director |
Sep 6, 2019 | |
| Jose Ubaldo Esparza |
Corporate Officer |
Jan 20, 1994 | |
| Robert Young |
W-2 Managing Employee |
Jan 6, 2012 | |
| Nadia Paola Alvarez |
Corporate Director |
Sep 6, 2019 | |
| Lucy Maria Herrera |
Corporate Director |
Nov 5, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100416000720 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 4284539966 | Practice locations: Garden Grove, CA |
National Provider Directory
- Tax ID family
- Altamed Health Service Corpotation
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | Yes |
Addresses
Primary practice location
12751 Harbor Blvd
Garden Grove, CA 92840-5800
Mailing address
2040 Camfield Ave
Los Angeles, CA 90040-1501
Phone (714) 636-7852
Other names
- AltaMed Medical Group- Garden Grove,Harbor
Other providers in Garden Grove, CA
- Ruthie Marie Alonzo
- Alphaped Pediatric Wellness Group
- Zahraa Alsraihat
- Alta Care Center, LLC
- Alta Home Health Care Services, Inc.
- Altamed Health Services Corp
- Berenice Altamirano
- Griselda Alvarado
- Lesly Alvarado
- Lidia Alvarado
All providers in Garden Grove, CA · Community Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.