NPIMap

Organization Active NPI

Valley-Wide Health Systems, Inc

Doing business as Guadalupe Health Center

  • Federally Qualified Health Center (FQHC)
  • Antonito, CO
National Provider Identifier
1508853813
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VALLEY-WIDE HEALTH SYSTEMS, INC
Doing business as
Guadalupe Health Center
Practice address
10TH and Dahlia
Antonito, CO 81120
Phone
(719) 376-5426
Fax
(719) 376-5880
NPI assigned
Oct 3, 2005
Last updated
May 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2024

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

Authorized official

Name
Jania Arnoldi
Title
President/Ceo
Phone
(719) 589-5161

Specialties & licenses 1

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

Addresses

Primary practice location

10TH and Dahlia
Antonito, CO 81120

Mailing address

128 Market St
Alamosa, CO 81101-2290
Phone (719) 587-1001

Other identifiers 3

IdentifierTypeStateIssuer
75508222MedicaidCO
VAC 4808OtherCOANTHEM BCBS
CE 9669OtherCOTRAVELERS MEDICARE NUMBER

Other names 1

  • Guadalupe Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040105000171 CO Part A Provider - Federally Qualified Health Center (FQHC) 5991609067 Practice locations: Antonito, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508853813. Details of each certification follow.

Federally qualified health center certification: CCN 061820

Legal name
VALLEY-WIDE HEALTH SYSTEMS, INC.
Doing business as
GUADALUPE HEALTH CENTER
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
CorporationNon-profit
Incorporated
Apr 15, 1976 in CO
Enrollment address
W 10TH Ave and Dahlia St
Antonito, CO 81120

National Provider Directory

National Provider Directory
Tax ID family
Valley-Wide Health Systems Inc34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

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

View all 33

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Javier Martinez Individual W-2 Managing EmployeeCfo Mar 1, 2019
Sally Espinoza Individual Corporate Director Mar 30, 2016
Jennifer Pollmiller Individual Corporate Director Jan 26, 2022
Jania Arnoldi Individual Corporate DirectorCeo/President Mar 15, 2019
W-2 Managing EmployeeCeo/President Mar 15, 2019
Linda Deherrera Individual Corporate Director Feb 28, 2018
Mattew Martinez Individual Corporate Director Sep 27, 2017
Jeremy Silva Individual Corporate Director Oct 23, 2019
Michelle Ferrera Individual Corporate Director Feb 27, 2019
Michelle Ballantyne Individual Corporate Director Mar 22, 2017
Patricia Freda Individual Corporate Director Apr 29, 2015

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Valley-Wide Health Systems, Inc.Canon City, CO, CCN 061019 Federally qualified health center Other Aug 17, 2020

NPI Registry JSON

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715558400000",
    "number": "1508853813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 MARKET ST",
            "city": "ALAMOSA",
            "state": "CO",
            "postal_code": "811012290",
            "telephone_number": "719-587-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10TH AND DAHLIA",
            "city": "ANTONITO",
            "state": "CO",
            "postal_code": "81120",
            "telephone_number": "719-376-5426",
            "fax_number": "719-376-5880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY-WIDE HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "ARNOLDI",
        "authorized_official_first_name": "JANIA",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "719-589-5161"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "75508222",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "VAC 4808",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVELERS MEDICARE NUMBER",
            "identifier": "CE 9669",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Guadalupe Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Guadalupe Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Antonito, CO

Sources for this page

Verify at the official NPI Registry.