NPIMap

Organization Active NPI

Friends of Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Pico Rivera, CA
National Provider Identifier
1124758727
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FRIENDS OF FAMILY HEALTH CENTER
Practice address
5062 Rosemead Blvd
Pico Rivera, CA 90660-2402
Phone
(562) 801-2287
Fax
(562) 690-3182
NPI assigned
Jun 15, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

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

Authorized official

Name
Nicolis Arias
Title
Credentialing
Phone
(562) 690-0400

Specialties & licenses 1

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

Addresses

Primary practice location

5062 Rosemead Blvd
Pico Rivera, CA 90660-2402

Mailing address

501 S Idaho St Ste 100
La Habra, CA 90631-6047
Phone (562) 690-0400

Other identifiers 1

IdentifierTypeStateIssuer
FHCX10068MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110323000139 CA Part B Supplier - Clinic/Group Practice 7315120730 Receives reassigned benefits from 18 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: La Habra, CA; Whittier, CA; Tustin, CA; Ontario, CA; La Puente, CA; Pico Rivera, CA
O20221130001070 CA Part A Provider - Federally Qualified Health Center (FQHC) 7315120730 Practice locations: Pico Rivera, CA

Federally qualified health center certification: CCN A01128

Legal name
FRIENDS OF FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 18, 2022
Last certification
Nov 18, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 2022 in CA
Enrollment address
5062 Rosemead Blvd
Pico Rivera, CA 90660-2402

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Friends of Family Health Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

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
Kathleen Sauble Individual Corporate DirectorBoard Member Nov 1, 2022 100%
Maida I Valencia Individual Operational/Managerial ControlDirector of Revenue Cycle Nov 1, 2022 100%
David Deleon Individual Corporate DirectorBoard Member Nov 1, 2022 100%
Mojgan Manshadi Individual Corporate DirectorBoard Member Nov 1, 2022 100%
Salvador H. Cervantes Individual Corporate DirectorBoard Member Nov 1, 2022 100%
Amanda Aviles Individual Corporate DirectorBoard Member Feb 13, 2025 100%
Sherleen Thao Le Individual Corporate DirectorBoard Member Feb 13, 2025 100%
Dung Ngoc Tran Individual Corporate OfficerCfo Nov 1, 2022 100%
Elizabeth Walker Individual Corporate DirectorBoard Member Nov 1, 2022 100%
Tyson Shih Individual Corporate DirectorBoard Member Nov 1, 2022 100%
Bahram Bahremand Individual Corporate OfficerCeo Nov 1, 2022 100%
Robert C. Gire Individual Corporate DirectorBoard Member Nov 1, 2022 100%

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 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Friends of Family Health CenterLa Habra, CA, CCN 751018 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2010
Friends of Family Health CenterTustin, CA, CCN 751818 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2010

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1655251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655251200000",
    "number": "1124758727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S IDAHO ST STE 100",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906316047",
            "telephone_number": "562-690-0400",
            "fax_number": "562-690-3182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5062 ROSEMEAD BLVD",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906602402",
            "telephone_number": "562-801-2287",
            "fax_number": "562-690-3182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRIENDS OF FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-15",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A",
        "authorized_official_last_name": "ARIAS",
        "authorized_official_first_name": "NICOLIS",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "562-690-0400"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHCX10068",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pico Rivera, CA

Sources for this page

Verify at the official NPI Registry.