NPIMap

Organization Active NPI

Los Angeles Christian Health Centers

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1497009245
Registry record updated May 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
960000972 Issued in CA
Legal business name
LOS ANGELES CHRISTIAN HEALTH CENTERS
Practice address
1920 Marengo St
Los Angeles, CA 90033-1317
Phone
(323) 276-6450
NPI assigned
Nov 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2021

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

Authorized official

Name
Bettina Lewis
Title
Coo
Phone
(213) 893-1960

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 960000972 CA Primary

Addresses

Primary practice location

1920 Marengo St
Los Angeles, CA 90033-1317

Mailing address

453 S Spring St Ste 1201
Los Angeles, CA 90013-2093
Phone (213) 893-1960

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250722001391 CA Part A Provider - Federally Qualified Health Center (FQHC) 8224114210 Practice locations: Los Angeles, CA

Federally qualified health center certification: CCN A01966

Legal name
LOS ANGELES CHRISTIAN HEALTH CENTERS
Doing business as
EXODUS RECOVERY - ICM
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 21, 2025
Last certification
Jul 21, 2025
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
1920 Marengo St
Los Angeles, CA 90033-1317

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Los Angeles Christian Health Centers14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

325 E 7th St
Los Angeles, CA 90014
Phone (818) 669-1104

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
Stacy Bolden-Bowers Individual Corporate DirectorBoard Chair Aug 1, 2017
Wayne T Aoki Individual Corporate DirectorBoard Member Oct 1, 2019
Troy Vaughn Individual Corporate DirectorBoard Member Dec 1, 2022
Erica Dubose Individual W-2 Managing EmployeeRevenue Cycle Manager Sep 17, 2019
Terrye Finley Individual Corporate Director Apr 1, 2012
Kim Mealy Individual Corporate DirectorBoard Member Aug 1, 2020
John J Hong Individual Corporate Director Jan 1, 2007
Kendell Simmons Individual Corporate DirectorBoard Member Dec 1, 2020
Kenneth Towler Individual Corporate DirectorBoard Member Mar 1, 2022
Bettina Hubbard-Lewis Individual 5% Or Greater Direct Ownership InterestCeo Sep 15, 2022
Corporate OfficerCeo Sep 15, 2022 100%
W-2 Managing EmployeeCeo Jul 1, 2015 100%
Operational/Managerial ControlCeo Sep 15, 2022 100%
Edward Seungse Lee Individual Corporate DirectorBoard Member Nov 1, 2004
Stephen Kennedy Individual Corporate OfficerCfo Aug 1, 2019
W-2 Managing EmployeeCfo Aug 1, 2019

Owners & managing parties with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1351728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620345600000",
    "number": "1497009245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "453 S SPRING ST STE 1201",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900132093",
            "telephone_number": "213-893-1960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 MARENGO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900331317",
            "telephone_number": "323-276-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOS ANGELES CHRISTIAN HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-01",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "BETTINA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "213-893-1960"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "960000972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.