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Organization Active NPI

East Valley Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Covina, CA
National Provider Identifier
1285046847
Registry record updated Feb 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
960000806 Issued in CA
Legal business name
EAST VALLEY COMMUNITY HEALTH CENTER, INC.
Practice address
276 West College Street
Covina, CA 91723-1902
Phone
(626) 919-4333
Fax
(626) 919-2084
NPI assigned
May 29, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2022

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

Authorized official

Name
Alicia Mardini
Title
Chief Exec. Officer
Phone
(626) 919-4333

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Federally Qualified Health Center (FQHC) 261QF0400X
Federally Qualified Health Center (FQHC) 261QF0400X 960000806 CA Primary

Addresses

Primary practice location

276 West College Street
Covina, CA 91723-1902

Mailing address

420 South Glendora Avenue
West Covina, CA 91790-3001
Phone (626) 919-4333

Other identifiers 1

IdentifierTypeStateIssuer
FHC12048FMedicaidCA

Other names 1

  • East Valley Community Health Center, Inc.-Intercommunity Campus Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050425000560 CA Part B Supplier - Clinic/Group Practice 9234041765 Receives reassigned benefits from 66 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Covina, CA; Pomona, CA; West Covina, CA
O20150428000584 CA Part A Provider - Federally Qualified Health Center (FQHC) 9234041765 Practice locations: Covina, CA

Federally qualified health center certification: CCN 751156

Legal name
EAST VALLEY COMMUNITY HEALTH CENTER, INC.
Doing business as
EAST VALLEY COMMUNITY HEALTH CENTER, INC COVINA HEALTH CENTER
Organization structure
CorporationNon-profit
Incorporated
Apr 16, 1970 in CA
Enrollment address
276 W College St
Covina, CA 91723-1902

Other NPIs with the same Medicare PAC ID 3

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

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
Francisco J Benavides Individual Corporate OfficerChief Financial Officer Mar 28, 2023
W-2 Managing EmployeeChief Financial Officer Mar 28, 2023
Laura Miranda Individual Corporate DirectorBoard Member Mar 28, 2023
Elisa Jimenez Individual Corporate DirectorBoard Member Mar 28, 2023
Doran Barnes Individual Corporate DirectorBoard Member Sep 24, 2003
Thomas D Allison Individual Corporate DirectorBoard Member Apr 25, 2012
Tony Song Individual Corporate DirectorBoard Member Dec 15, 2005
Chinhnam Hathuc Individual Corporate OfficerChief Medical Officer Jul 1, 2014
W-2 Managing EmployeeChief Medical Officer Jul 1, 2014
Areceli Lopez Individual Corporate DirectorBoard Member Mar 28, 2023
Alicia Mardini Individual Corporate OfficerChief Executive Officer Jul 1, 1983
W-2 Managing EmployeeChief Executive Officer Jul 1, 1983
Robert Beam Individual Corporate DirectorBoard Member Jun 25, 2014
Chalikorn M Chan Individual Corporate DirectorBoard Member Mar 28, 2023
Joe Leal Individual Corporate DirectorBoard Member Mar 28, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 60

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

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644537600000",
    "number": "1285046847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 SOUTH GLENDORA AVENUE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903001",
            "telephone_number": "626-919-4333",
            "fax_number": "626-919-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 WEST COLLEGE STREET",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917231902",
            "telephone_number": "626-919-4333",
            "fax_number": "626-919-2084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST VALLEY COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-29",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A",
        "authorized_official_last_name": "MARDINI",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "CHIEF EXEC. OFFICER",
        "authorized_official_telephone_number": "626-919-4333"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "960000806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC12048F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Valley Community Health Center, Inc.-Intercommunity Campus",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "East Valley Community Health Center, Inc.-Intercommunity Campus",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.