NPIMap

Organization Active NPI

H Street Clinic

  • Federally Qualified Health Center (FQHC)
  • Inglewood, CA
National Provider Identifier
1548610322
Registry record updated Apr 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
H STREET CLINIC
Practice address
2710 W Manchester Blvd
Inglewood, CA 90305-2436
Phone
(323) 778-4310
Fax
(323) 778-0838
NPI assigned
Jun 13, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2022

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

Authorized official

Name
Eleanor Perez
Title
Cao
Phone
(626) 488-3111

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Case Management Agency 251B00000X
Supports Brokerage Agency 251X00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2710 W Manchester Blvd
Inglewood, CA 90305-2436

Mailing address

714 W Olympic Blvd Ste 801
Los Angeles, CA 90015-1440
Phone (213) 536-5815

Other names 1

  • Central Neighborhood Health Foundation - Inglewood Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090522000321 CA Part B Supplier - Clinic/Group Practice 3870693781 Receives reassigned benefits from 14 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Inglewood, CA; Long Beach, CA; Riverside, CA; San Bernardino, CA
O20200921002903 CA Part A Provider - Federally Qualified Health Center (FQHC) 3870693781 Practice locations: Inglewood, CA

Federally qualified health center certification: CCN 921949

Legal name
H STREET CLINIC
Doing business as
CENTRAL NEIGHBORHOOD HEALTH FOUNDATION INGLEWOOD CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 14, 2020
Last certification
Sep 14, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 18, 2006 in CA
Enrollment address
2710 W Manchester Blvd
Inglewood, CA 90305-2436

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
H Street Clinic14 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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2700 S Grand Ave
Los Angeles, CA 90007
Phone (213) 315-9110

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Crystal Lautrup Individual Corporate DirectorCredentialing Chair Sep 9, 2009
James Mackey Individual Corporate DirectorBoard Member Oct 29, 2020
Central Neighborhood Health Foundation Organization, Los Angeles, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 10, 2014 100%
Operational/Managerial Control Nov 10, 2014 100%
Victor Garcia Individual Corporate DirectorBoard Member Aug 23, 2018
Kenneth M. Orduna Individual Corporate OfficerCeo May 1, 2011
W-2 Managing EmployeeCeo May 1, 2011 100%
Richard Mayer Individual Corporate DirectorBoard Treasurer Feb 18, 2009
Oscar Lopez Individual Corporate DirectorBoard Member Oct 25, 2018
Victor Thompson Individual Corporate DirectorBoard Member Feb 8, 2020

Owners & managing parties with NPI records 1

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1465776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648771200000",
    "number": "1548610322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 W OLYMPIC BLVD STE 801",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900151440",
            "telephone_number": "213-536-5815",
            "fax_number": "213-478-0172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 W MANCHESTER BLVD",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903052436",
            "telephone_number": "323-778-4310",
            "fax_number": "323-778-0838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "H STREET CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-13",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "ELEANOR",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "626-488-3111"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Neighborhood Health Foundation - Inglewood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Inglewood, CA

Sources for this page

Verify at the official NPI Registry.