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El Centro Family Health

Organization Active NPI Federally Qualified Health Center (FQHC) · Las Vegas, NM

NPI 1316475403 · NPPES record last updated Jun 7, 2023

Key facts

NPI
1316475403
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
EL CENTRO FAMILY HEALTH
Practice address
475 Legion Dr.
Las Vegas, NM 87701
Phone
(505) 425-6788
NPI assigned
Jun 1, 2017
Organization subpart
Yes
Parent organization (as reported)
EL CENTRO FAMILY HEALTH

Authorized official

Name
Heather Rector
Title
Credentialing Specialist II
Phone
(505) 747-5946

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 18

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

Corporate family (same tax ID) 9

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

Practitioners 32

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

View all 32

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NM

Federally qualified health center certification: CCN 321957

Legal name
EL CENTRO FAMILY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 17, 2017
Last certification
Oct 17, 2017
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Sep 1, 1972 in NM
Enrollment address
475 Legion Dr
Las Vegas, NM 87701

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Paul a Guiles
Individual 		Corporate Director Aug 1, 2008
Sylvia a Vigil
Individual 		Corporate Director Jan 1, 2013
Evaristo Maestas
Individual 		Corporate Director Mar 1, 2009
Nesha Morse
Individual 		Corporate Director Dec 1, 2013
Richard C Frey
Individual 		Corporate Director Oct 1, 2008
Jerome Williams
Individual 		Contracted Managing Employee
Coo		 Dec 12, 2015
Corporate Director Dec 12, 2015
W-2 Managing Employee Dec 12, 2015
Operational/Managerial Control Dec 12, 2015
Juliet Garcia-Gonzales
Individual 		Corporate Director Aug 26, 2015
Jackie Feeler
Individual 		Corporate Director Feb 1, 2013
Janette Archuleta
Individual 		Corporate Director Mar 1, 2012

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Robertson High School Based Clinic
Las Vegas, NM · CCN 321952		 Federally qualified health center Operational/Managerial Control Sep 7, 2016

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20171019002308 NM Part a Provider - Federally Qualified Health Center (FQHC) 9830080688 Practice locations: Las Vegas, NM

National Provider Directory

Tax ID family
Health Centers of North (10 organizations share this tax ID)
Part of
Health Centers of North

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

475 Legion Dr.
Las Vegas, NM 87701

Mailing address

PO Box 158
Espanola, NM 87532-0158
Phone (505) 753-7218

Other names

  • Sierra Vista School Based Clinic Doing business as

Other providers in Las Vegas, NM

All providers in Las Vegas, NM · Federally Qualified Health Center (FQHC) in New Mexico

Sources for this page

Verify at the official NPI Registry.