NPIMap

Organization Active NPI

La Red Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Seaford, DE
National Provider Identifier
1497071161
Registry record updated Nov 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA RED HEALTH CENTER, INC.
Practice address
300 High St
Seaford, DE 19973-3940
Phone
(302) 855-1233
NPI assigned
Apr 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2013

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

Authorized official

Name
Brian Olson
Title
Chief Executive Officer
Phone
(302) 855-2020

Specialties & licenses 1

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

Addresses

Primary practice location

300 High St
Seaford, DE 19973-3940

Mailing address

21444 Carmean Way
Georgetown, DE 19947-4572

Other identifiers 1

IdentifierTypeStateIssuer
1497071161MedicaidDE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070306000183 DE Part B Supplier - Clinic/Group Practice 4789668815 Receives reassigned benefits from 32 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Georgetown, DE; Seaford, DE; Milford, DE
O20111130000398 DE Part A Provider - Federally Qualified Health Center (FQHC) 4789668815 1 other NPI on this enrollment
Practice locations: Seaford, DE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497071161. Details of each certification follow.

Federally qualified health center certification: CCN 081812

Legal name
LA RED HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 30, 2011
Last certification
Nov 30, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 2002 in DE
Enrollment address
300 High Street
Seaford, DE 19973-3940

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
08D2006427La Red Health Center, Inc300 High Street, Seaford, DE 19973Provider-performed microscopyApr 20, 2028

National Provider Directory

National Provider Directory
Tax ID family
La Red Health Care8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

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
Laurie Anderson Individual Corporate DirectorStaff Member Aug 1, 2024
George Walker Individual Corporate DirectorBoard President Feb 8, 2017
Bet K Wong Individual Corporate DirectorBoard Member Mar 1, 2024
Rony Baltazar Individual Corporate Director Jul 19, 2023
Gertha Jean Individual Corporate Director Nov 13, 2019
Tonika L Ward Individual Corporate Director Nov 15, 2023
Tanya Harris Individual Corporate DirectorBoard Secretary Feb 10, 2021
Velma Norwood Individual Corporate DirectorBoard VP Nov 14, 2007
Usda Department of Agriculture Rural Development Organization, Dover, DE Created for acquisition, Non-profit 5% Or Greater Mortgage Interest Jul 28, 2012 40%
Kathleen Russell Individual Corporate DirectorBoard Member Feb 10, 2021
Lissette Galloza Individual Corporate DirectorBoard Member Nov 13, 2019
Bianca a Mojica Individual Corporate DirectorBoard Member Jul 9, 2014
Judith Johnson Individual Corporate DirectorBoard Treasurer Oct 8, 2008
Michael McGroerty Individual Corporate DirectorBoard Member Dec 11, 2019
Brian S Olson Individual Corporate DirectorCeo Aug 1, 2001 100%
W-2 Managing EmployeeCeo Aug 1, 2001 100%
Jasmine Finley Individual Corporate DirectorStaff Member Aug 1, 2024

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384473600000",
    "number": "1497071161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21444 CARMEAN WAY",
            "city": "GEORGETOWN",
            "state": "DE",
            "postal_code": "199474572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HIGH ST",
            "city": "SEAFORD",
            "state": "DE",
            "postal_code": "199733940",
            "telephone_number": "302-855-1233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA RED HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-20",
        "last_updated": "2013-11-15",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "302-855-2020"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497071161",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seaford, DE

Sources for this page

Verify at the official NPI Registry.