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El Centro Family Health

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

NPI 1457798712 · NPPES record last updated Nov 21, 2014

Key facts

NPI
1457798712
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
EL CENTRO FAMILY HEALTH
Practice address
1260 Industrial Park Rd
Espanola, NM 87532-3503
Phone
(505) 753-1348
Fax
(505) 747-7332
NPI assigned
May 28, 2013
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).

Corporate family (same tax ID) 9

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

Practitioners 35

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

View all 35

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NM

Federally qualified health center certification: CCN 321934

Legal name
EL CENTRO FAMILY HEALTH
Doing business as
EL CENTRO FAMILY HEALTH CARLOS VIGIL MIDDLE SCHOOL-BASED HEALTH CARE C
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 16, 2014
Last certification
Sep 16, 2014
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Nov 6, 1975 in NM
Enrollment address
1260 Industrial Park Road
Espanola, NM 87532-3503

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
Rosalie Lopez
Individual 		Corporate Director
Board Member		 May 28, 2014
Lore Pease
Individual 		Corporate Officer
Ceo		 Jun 6, 2007
Lebeo Martinez
Individual 		Corporate Director
Board Member		 Nov 1, 1994
Richard C Frey
Individual 		Corporate Director
Board Member		 Oct 1, 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		 Oct 10, 2011
Lynsey Wheeler
Individual 		Corporate Director
Board Member		 Aug 1, 2012
Lucille Montoya
Individual 		W-2 Managing Employee
Chief Operations Manager		 Aug 24, 2011
Sinforosa Lovato
Individual 		Corporate Director
Board Member		 Feb 1, 1985
Jackie Feeler
Individual 		Corporate Director
Board Member		 Feb 1, 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
O20140917000184 NM Part a Provider - Federally Qualified Health Center (FQHC) 9830080688 Practice locations: Espanola, NM

National Provider Directory

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

Locations

1260 Industrial Park Rd
Espanola, NM 87532
Phone (505) 367-3342

Specialties & licenses

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

Addresses

Primary practice location

1260 Industrial Park Rd
Espanola, NM 87532-3503

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
215159844MedicaidNM
1780689034OtherNMNPPES

Other names

  • El Centro Family Health CVMHS SBHC Other name

Other providers in Espanola, NM

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

Sources for this page

Verify at the official NPI Registry.