NPIMap

Organization Active NPI

All-Inclusive Community Health Center

  • Primary Care Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1174996177
Registry record updated Nov 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ALL-INCLUSIVE COMMUNITY HEALTH CENTER
Practice address
3920 Eagle Rock Blvd Ste a
Los Angeles, CA 90065-3606
Phone
(323) 255-5225
Fax
(323) 255-5229
NPI assigned
Nov 12, 2015
Last updated
Nov 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2018

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

Authorized official

Name
Marine Dzhgalyan
Title
Ceo
Phone
(818) 843-9900

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X CA
Federally Qualified Health Center (FQHC) 261QF0400X NU
Primary Care Clinic/Center 261QP2300X CA Primary

Addresses

Primary practice location

3920 Eagle Rock Blvd Ste a
Los Angeles, CA 90065-3606

Mailing address

1311 N San Fernando Blvd
Burbank, CA 91504-4236
Phone (818) 843-9900

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidCA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110906000533 CA Part B Supplier - Clinic/Group Practice 5294905006 Receives reassigned benefits from 16 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Burbank, CA; Los Angeles, CA; Northridge, CA
O20160126002138 CA Part A Provider - Federally Qualified Health Center (FQHC) 5294905006 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174996177. Details of each certification follow.

Federally qualified health center certification: CCN 751834

Legal name
ALL-INCLUSIVE COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 26, 2016
Last certification
Jan 26, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 23, 2010 in CA
Enrollment address
3920 Eagle Rock Blvd
Ste a
Los Angeles, CA 90065-3606

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
All-Inclusive Community Health Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Maria Castaneda Individual Corporate DirectorBoard Member Jun 23, 2014
Marine Dzhgalyan Individual Corporate OfficerCeo Aug 27, 2012
W-2 Managing EmployeeCeo Aug 27, 2012
Giovanni Rodriguez Individual Corporate DirectorBoard Member Jun 23, 2014
Aida Peralta Individual Corporate DirectorBoard Member Jun 10, 2011
Araik Gukasyan Individual Corporate DirectorBoard Member-Secretary/Treasurer Jan 3, 2011
Mariam Kuregyan Individual Corporate DirectorBoard Member, Board Chair Jun 10, 2011
Gor Agababian Individual Corporate OfficerCmo Nov 15, 2011
W-2 Managing EmployeeCmo Nov 15, 2011
All-Inclusive Community Health Center Organization, Burbank, CA Corporation, Non-profit 5% Or Greater Security Interest Dec 1, 2015 100%
Kristina Atalaryan Individual Corporate DirectorBoard Member Aug 28, 2014
Azniv Tashchyan Individual Corporate OfficerCfo Nov 25, 2013
W-2 Managing EmployeeCfo Nov 25, 2013
Jannett Garibian Individual Corporate DirectorBoard Member Jan 7, 2011
Parantzem Hairapetian Individual Corporate DirectorBoard Member Jan 7, 2011
Marlene Sanchez Individual Corporate DirectorBoard Member Sep 1, 2015
Sona Kazandjian Individual Corporate OfficerCoo Apr 1, 2013
W-2 Managing EmployeeCoo Apr 1, 2013

Owners & managing parties with NPI records 3

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
All-Inclusive Community Health CenterBurbank, CA, CCN 751015 Federally qualified health center Operational/Managerial Control Dec 18, 2012
All-Inclusive Community Health CenterNorthridge, CA, CCN 921887 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2019

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 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1447286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542240000000",
    "number": "1174996177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 N SAN FERNANDO BLVD",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915044236",
            "telephone_number": "818-843-9900",
            "fax_number": "818-843-9909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3920 EAGLE ROCK BLVD STE A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900653606",
            "telephone_number": "323-255-5225",
            "fax_number": "323-255-5229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALL-INCLUSIVE COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-12",
        "last_updated": "2018-11-15",
        "status": "A",
        "authorized_official_last_name": "DZHGALYAN",
        "authorized_official_first_name": "MARINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-843-9900"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.