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El Centro Family Health

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

NPI 1407011315 · NPPES record last updated Mar 4, 2015

Key facts

NPI
1407011315
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
License
6003 (NM)
Legal business name
EL CENTRO FAMILY HEALTH
Practice address
Hwy 68 #2243 Rinconada
Embudo, NM 87531-2627
Phone
(505) 579-4255
Fax
(505) 579-4669
NPI assigned
Jul 21, 2008
Organization subpart
No

Authorized official

Name
Mrs. Lore Pease
Title
Ceo
Phone
(505) 753-7218

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).

Practitioners 33

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

View all 33

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NM

Federally qualified health center certification: CCN 321829

Legal name
EL CENTRO FAMILY HEALTH
Doing business as
EL CENTRO FAMILY HEALTH EMBUDO VALLEY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Oct 1, 1972 in NM
Enrollment address
2243 Highway 68
Embudo, NM 87531-0098

All disclosed owners & managing parties 16

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
Board Member		 Aug 1, 2008
Sylvia a Vigil
Individual 		Corporate Director
Board Member		 Jan 1, 2013
Evaristo Maestas
Individual 		Corporate Director
Board Member		 Mar 1, 2009
Nesha Morse
Individual 		Corporate Director
Board Member		 Dec 1, 2013
Ryan Baca
Individual 		Corporate Director
Board Member		 Oct 29, 2014
Lore Pease
Individual 		Corporate Director Dec 15, 2008
W-2 Managing Employee Dec 15, 2008
Lebeo Martinez
Individual 		Corporate Director Dec 17, 2008
Richard C Frey
Individual 		Corporate Director Dec 17, 2008
Gary Reece
Individual 		Corporate Director
Board Member		 Mar 26, 2014
Pearl Maestas
Individual 		Corporate Director
Board Member		 Nov 1, 2011
Francine Kain
Individual 		Corporate Officer
Cfo		 Sep 10, 2011
W-2 Managing Employee
Chief Financial Officer		 Sep 10, 2011
Juliet Garcia-Gonzales
Individual 		Corporate Director
Board Member		 Sep 25, 2015
Lucille Montoya
Individual 		W-2 Managing Employee
Chief Operations Officer		 Jan 1, 2002
Sinforosa Lovato
Individual 		Corporate Director
Board Member		 Feb 1, 1985
Jackie Feeler
Individual 		Corporate Director
Board Member		 Feb 6, 2013
Janette Archuleta
Individual 		Corporate Director
Board Member		 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
O20090113000901 NM Part a Provider - Federally Qualified Health Center (FQHC) 9830080688 Practice locations: Embudo, NM

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 6003 NM Yes

Addresses

Primary practice location

Hwy 68 #2243 Rinconada
Embudo, NM 87531-2627

Mailing address

538 N Paseo de Onate
P.O. Box 158
Espanola, NM 87532-2618
Phone (505) 753-7218

Other identifiers

IdentifierTypeStateIssuer
1780689034OtherNMORGANIZATION NPPES
47498MedicaidNM

Other names

  • El Centro Family Health Embudo Clinic Other name

Other providers in Embudo, NM

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

Sources for this page

Verify at the official NPI Registry.