Tri-State Community Healthcare Center

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

TRI-STATE COMMUNITY HEALTHCARE CENTER

Practice address

11499 Bartlett Ave
Adelanto, CA 92301-1902

Phone

(760) 444-4258

NPI assigned

Nov 7, 2017

Last updated

Sep 21, 2026By the provider in NPPES

Organization subpart

Yes

Parent organization

TRI-STATE COMMUNITY HEALTHCARE CENTERAs reported in NPPES

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

Authorized official

Name

Crystale Mineros

Title

Credentialing Manager

Phone

(909) 575-7161

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508379017. Details of each certification follow.

• CCN 921090 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 921090

Legal name

TRI-STATE COMMUNITY HEALTHCARE CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

May 21, 2018

Last certification

May 21, 2018

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Apr 1, 2012 in CA

Enrollment address

11499 Bartlett Ave
Adelanto, CA 92301-1902

Other NPIs with the same Medicare PAC ID 3

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

• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Needles, CA
  • NPI 1922356369

  5597991968

  Same PAC ID
• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Laughlin, NV
  • NPI 1174125892

  5597991968

  Same PAC ID
• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Mohave Valley, AZ
  • NPI 1841703253

  5597991968

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Needles, CA
  • NPI 1922356369

  O20131114000307

  Same enrollment

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

CLIA laboratory certificates

Part of

Tri-State Comm Hlthcare Ctr

Locations

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 3

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

• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Needles, CA
  • NPI 1922356369

  Operational/Managerial Control

  CMS ownership
• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Laughlin, NV
  • NPI 1174125892

  Operational/Managerial Control

  CMS ownership
• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Mohave Valley, AZ
  • NPI 1841703253

  Operational/Managerial Control

  CMS ownership

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Needles, CA
  • NPI 1922356369

  Operational/Managerial Control

  CMS ownership
• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Laughlin, NV
  • NPI 1174125892

  5% Or Greater Direct Ownership Interest

  CMS ownership

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Needles, CA
  • NPI 1922356369

  Tri-State Community Healthcare Center

  CMS ownership
• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Laughlin, NV
  • NPI 1174125892

  Tri-State Community Healthcare Center

  CMS ownership

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.

• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Needles, CA
  • NPI 1922356369
  NPPES parent name

Practitioners 44

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.

• Ebram Abdelmalak, DPM

  • Foot & Ankle Surgery Podiatrist
  • El Monte, CA
  • NPI 1225412000
  NPD
• Tolulope Titilayo Adedayo, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Hemet, CA
  • NPI 1235690397
  NPD
• Parviz Akhavan, D.O

  • General Practice Physician
  • Los Angeles, CA
  • NPI 1235286436
  NPD
• Dana Jeries Alrabadi

  • Family Nurse Practitioner
  • Ontario, CA
  • NPI 1952852741
  NPD
• Adamma Theresa Amadi, FNP

  • Primary Care Nurse Practitioner
  • Cerritos, CA
  • NPI 1487030656
  NPD
• Arra Apikian, OD

  • Optometrist
  • Los Angeles, CA
  • NPI 1528726924
  NPD
• Kathy Le Ballek, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Los Angeles, CA
  • NPI 1295545150
  NPD
• Hind Bennani, DPM

  • Foot & Ankle Surgery Podiatrist
  • Rancho Palos Verdes, CA
  • NPI 1073702213
  NPD
• Zubeida Hassen Birhan, P.A.

  • Physician Assistant
  • Los Angeles, CA
  • NPI 1073688255
  NPD
• Kenrick Carlyle Bourne, PA-C

  • Physician Assistant
  • San Jacinto, CA
  • NPI 1063690931
  NPD
• Lesley Vanessa Carrillo, DMD

  • General Practice Dentistry
  • Huntington Park, CA
  • NPI 1225760358
  NPD
• Maria Cristina Enriquez, FNP-BC

  • Family Nurse Practitioner
  • Hemet, CA
  • NPI 1790427995
  NPD

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789948800000",
    "number": "1508379017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 E COLORADO ST",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912051513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11499 BARTLETT AVE",
            "city": "ADELANTO",
            "state": "CA",
            "postal_code": "923011902",
            "telephone_number": "760-444-4258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "540 N San Jacinto St Ste P",
            "address_purpose": "LOCATION",
            "city": "Hemet",
            "state": "CA",
            "postal_code": "925433154",
            "country_code": "US",
            "telephone_number": "951-929-4000",
            "fax_number": "951-929-4100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6630 Crenshaw Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900434102",
            "country_code": "US",
            "telephone_number": "213-686-1517",
            "fax_number": "213-686-1518",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1061 E Vernon Ave Ste F",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900113772",
            "country_code": "US",
            "telephone_number": "323-233-9686",
            "fax_number": "323-233-0595",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3600 E 1st St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900632326",
            "country_code": "US",
            "telephone_number": "323-694-0911",
            "fax_number": "323-694-0900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "540 N San Jacinto St Ste I",
            "address_purpose": "LOCATION",
            "city": "Hemet",
            "state": "CA",
            "postal_code": "925433154",
            "country_code": "US",
            "telephone_number": "951-651-1006",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1532 San Bernardino Ave Ste A2",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917673559",
            "country_code": "US",
            "telephone_number": "909-301-4041",
            "fax_number": "909-301-4042",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11273 Laurel Canyon Blvd Ste 2",
            "address_purpose": "LOCATION",
            "city": "San Fernando",
            "state": "CA",
            "postal_code": "913404357",
            "country_code": "US",
            "telephone_number": "818-853-2220",
            "fax_number": "818-853-2221",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1532 San Bernardino Ave Ste B7",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917673559",
            "country_code": "US",
            "telephone_number": "909-301-4041",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11888 Bartlett Ave",
            "address_purpose": "LOCATION",
            "city": "Adelanto",
            "state": "CA",
            "postal_code": "923011709",
            "country_code": "US",
            "telephone_number": "760-530-9944",
            "fax_number": "760-530-9977",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4137 Verdugo Rd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900653820",
            "country_code": "US",
            "telephone_number": "323-344-9255",
            "fax_number": "323-344-8776",
            "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": "2017-11-07",
        "last_updated": "2026-09-21",
        "certification_date": "2026-09-21",
        "status": "A",
        "authorized_official_last_name": "MINEROS",
        "authorized_official_first_name": "CRYSTALE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "909-575-7161"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Universal of Science and Peace
• Russhya Thomas
• Berenice Torres Garcia
• Elizabeth Torres
• Tri-State Community Healthcare Center
• Tri-State Community Healthcare Center
• Brandy Nicole Trimble
• Karen Villalobos, MFT/PCC
• Edna M Washington, BSHS
• Christine Louise Watson

• Federally Qualified Health Center (FQHC) in Adelanto, CA
• Providers in Adelanto, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.