NPIMap

Organization Active NPI

Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Adelanto, CA
National Provider Identifier
1336646397
Registry record updated Apr 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRI-STATE COMMUNITY HEALTHCARE CENTER
Practice address
11888 Bartlett Ave
Adelanto, CA 92301-1709
Phone
(760) 326-0222
NPI assigned
Apr 6, 2018
Last updated
Apr 6, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
TRI-STATE COMMUNITY HEALTHCARE CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 6, 2018

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

Authorized official

Name
Aram Manoukian
Title
Ceo
Phone
(760) 326-0222

Specialties & licenses 1

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

Addresses

Primary practice location

11888 Bartlett Ave
Adelanto, CA 92301-1709

Mailing address

1402 Bailey Ave
Needles, CA 92363-3104

Other practice location 1

1402 Bailey Ave
Needles, CA 92363-3104
Phone (760) 326-0222

Other names 1

  • MOBILE CLINIC Other name

National Provider Directory

National Provider Directory
Tax ID family
Tri-State Comm Hlthcare Ctr12 organizations share this tax ID, including this one
Part of
Tri-State Comm Hlthcare Ctr

Other organizations with this tax ID 11

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

Locations

11888 Bartlett Ave
Adelanto, CA 92301
Phone (760) 530-9944

1402 Bailey Ave
Needles, CA 92363
Phone (760) 326-0222

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1522972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522972800000",
    "number": "1336646397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1402 BAILEY AVE",
            "city": "NEEDLES",
            "state": "CA",
            "postal_code": "923633104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11888 BARTLETT AVE",
            "city": "ADELANTO",
            "state": "CA",
            "postal_code": "923011709",
            "telephone_number": "760-326-0222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1402 Bailey Ave",
            "address_purpose": "LOCATION",
            "city": "Needles",
            "state": "CA",
            "postal_code": "923633104",
            "country_code": "US",
            "telephone_number": "760-326-0222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRI-STATE COMMUNITY HEALTHCARE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRI-STATE COMMUNITY HEALTHCARE CENTER",
        "enumeration_date": "2018-04-06",
        "last_updated": "2018-04-06",
        "status": "A",
        "authorized_official_last_name": "MANOUKIAN",
        "authorized_official_first_name": "ARAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-326-0222"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOBILE CLINIC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "MOBILE CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Adelanto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.