NPIMap

Organization Active NPI

Desert Senita Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Ajo, AZ
National Provider Identifier
1114037496
Registry record updated Oct 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OTC-0274 Issued in AZ
Legal business name
DESERT SENITA COMMUNITY HEALTH CENTER
Doing business as
Desert Senita Community Health Center
Practice address
410 N Malacate St
Ajo, AZ 85321-2254
Phone
(520) 387-5651
Fax
(520) 387-5347
NPI assigned
Aug 30, 2006
Last updated
Oct 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2025

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

Authorized official

Name
Jennifer Ward
Title
Cfo
Phone
(520) 387-5651

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X OTC-0274 AZ Primary

Addresses

Primary practice location

410 N Malacate St
Ajo, AZ 85321-2254

Mailing address

410 N Malacate St
Ajo, AZ 85321-2254
Phone (520) 387-5651

Other identifiers 3

IdentifierTypeStateIssuer
155681MedicaidAZ
AZ0910930OtherAZBCBS
913034MedicaidAZ

Other names 1

  • DESERT SENITA COMMUNITY HEALTH CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040308000777 AZ Part B Supplier - Clinic/Group Practice 3476441866 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
Practice locations: Stanfield, AZ; Coolidge, AZ; Arizona City, AZ; Casa Grande, AZ; Ajo, AZ
O20100824000857 AZ Part A Provider - Federally Qualified Health Center (FQHC) 3476441866 Practice locations: Ajo, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114037496. Details of each certification follow.

Federally qualified health center certification: CCN 031831

Legal name
DESERT SENITA COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 22, 2000
Last certification
Aug 22, 2000
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 14, 1997 in AZ
Enrollment address
410 N Malacate St
Ajo, AZ 85321-2254

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 5

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Dan Skiles Individual Corporate Director Jun 1, 2023
Cesar Cardenas Individual Corporate OfficerCoo Aug 13, 2023
W-2 Managing Employee Aug 13, 2023
Darlene Abel Individual Corporate Director Feb 28, 2024
Karen Jones Individual Corporate Director Feb 28, 2024
Stephanie Cosand Individual Corporate DirectorBoard Member Jan 1, 2023
Alicia Labeau Individual Corporate Director Feb 28, 2024
Jennifer Ward Individual Corporate OfficerCfo Jun 4, 2023
Mary Emma Poroli Individual Corporate Director Jul 30, 2025
Enedina Munoz Individual Corporate Director Feb 28, 2024
Sheila Ply Individual Corporate Director Dec 1, 2018
Jon Cameron Individual Corporate Director Jul 30, 2025
Tommy Thomas Individual Corporate Director Feb 28, 2024
Laura Cuplin Individual Corporate Director Feb 28, 2025
Jon Thompson Individual Corporate Director Feb 28, 2024
Allen Rogers Individual Corporate Director Feb 28, 2025
Michael Huntly Individual Corporate Director Feb 28, 2024

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759363200000",
    "number": "1114037496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 N MALACATE ST",
            "city": "AJO",
            "state": "AZ",
            "postal_code": "853212254",
            "telephone_number": "520-387-5651",
            "fax_number": "520-387-5347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 N MALACATE ST",
            "city": "AJO",
            "state": "AZ",
            "postal_code": "853212254",
            "telephone_number": "520-387-5651",
            "fax_number": "520-387-5347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT SENITA COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "520-387-5651"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OTC-0274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155681",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "AZ0910930",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "913034",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DESERT SENITA COMMUNITY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ajo, AZ

Sources for this page

Verify at the official NPI Registry.