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Organization Active NPI

Mora Valley Community Health Services Inc

  • Community Health Clinic/Center
  • Mora, NM
National Provider Identifier
1508840117
Registry record updated Oct 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
6333 Issued in NM
Legal business name
MORA VALLEY COMMUNITY HEALTH SERVICES INC
Practice address
3 Mora Valley Clinic Rd
Mora, NM 87732-2202
Phone
(877) 271-2201
NPI assigned
Dec 6, 2005
Last updated
Oct 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2025

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

Authorized official

Name
Mrs. Carla Melendez
Title
Cfo
Phone
(877) 271-2201

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 6333 NM Primary

Addresses

Primary practice location

3 Mora Valley Clinic Rd
Mora, NM 87732-2202

Mailing address

PO Box 209
Mora, NM 87732-0209
Phone (877) 271-2201

Other identifiers 1

IdentifierTypeStateIssuer
48504MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040301000532 NM Part B Supplier - Clinic/Group Practice 4486541901 Receives reassigned benefits from 7 practitioners
Practice locations: Mora, NM
O20110214000755 NM Part A Provider - Federally Qualified Health Center (FQHC) 4486541901 Practice locations: Mora, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508840117. Details of each certification follow.

Federally qualified health center certification: CCN 321803

Legal name
MORA VALLEY COMMUNITY HEALTH SERVICES INC
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
OtherNon-profit
Incorporated
Dec 21, 1978 in NM
Enrollment address
3 Mora Valley Clinic Rd
Mora, NM 87732-2202

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Cathy Martinez Individual Corporate Director Jan 6, 2014
Paul H Fort Individual Corporate Director Oct 14, 2013
Melanie Witt Individual Corporate Director Oct 14, 2013
Wanda Salazar Individual W-2 Managing Employee Dec 13, 2010
Jim G Popovich Individual Corporate Director Oct 14, 2013
Samuel Muniz Individual Corporate Director Dec 13, 2010
Rhonda Baquera Individual Corporate Director Dec 13, 2010
Gwen Moore Individual Corporate Director Dec 13, 2010
Charles Salazar Individual Corporate Director Dec 13, 2010
Julian F Barela Individual Corporate Director Oct 14, 2013
W-2 Managing Employee Oct 14, 2013
Karissa Serna Individual Corporate Director Jan 6, 2014

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760918400000",
    "number": "1508840117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 209",
            "city": "MORA",
            "state": "NM",
            "postal_code": "877320209",
            "telephone_number": "877-271-2201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 MORA VALLEY CLINIC RD",
            "city": "MORA",
            "state": "NM",
            "postal_code": "877322202",
            "telephone_number": "877-271-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORA VALLEY COMMUNITY HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-06",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A",
        "authorized_official_last_name": "MELENDEZ",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "877-271-2201",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NM",
            "license": "6333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48504",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mora, NM

Sources for this page

Verify at the official NPI Registry.