NPIMap

Organization Active NPI

Government of Guam Department of Administration

Doing business as Southern Region Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Inarajan, GU
National Provider Identifier
1629041546
Registry record updated Apr 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION
Doing business as
Southern Region Community Health Center
Practice address
162 Abman Drive
Inarajan, GU 96915-2816
Phone
(671) 828-7501
Fax
(671) 828-7504
NPI assigned
Feb 10, 2006
Last updated
Apr 12, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2013

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

Authorized official

Name
Ms. Linda Unpingco Denorcey
Title
Executive Director
Phone
(671) 635-4422

Specialties & licenses 1

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

Addresses

Primary practice location

162 Abman Drive
Inarajan, GU 96915-2816

Mailing address

162 Abman Drive
Inarajan, GU 96915-2816
Phone (671) 828-7501

Other names 1

  • Southern Region Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100724000005 GU Part A Provider - Federally Qualified Health Center (FQHC) 6103920525 Practice locations: Inarajan, GU

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629041546. Details of each certification follow.

Federally qualified health center certification: CCN 651800

Legal name
GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION
Doing business as
SOUTHERN REGION COMMUNITY 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
GovernmentNon-profit
Enrollment address
162 Apman Dr
Inarajan, GU 96917-2816

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Government of Guam Department of Administration13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Eileen N Damian Individual Corporate DirectorCHC Board Member Aug 9, 2017 5%
Allan RG Ungacta Individual Corporate DirectorCHC Board Member Jun 16, 2017 5%
Frances a Salas Individual Corporate DirectorCHC Board Member Oct 1, 2012
Melissa B Savares Individual Corporate DirectorCHC Board Member Jun 1, 2008 5%
Vicente C Meno Individual Corporate DirectorCHC Board Member Jun 1, 2001 5%
Reynaldo P Edrosa Individual Corporate DirectorCHC Board Member Jun 1, 2008 5%
January Suzuki Individual Corporate DirectorCHC Board Member Jul 27, 2017 5%
Sonya a Sanchez Individual Corporate DirectorCHC Board Member Jun 1, 2004 5%
Government of Guam Department of Administration Organization, Hagatna, GU 5% Or Greater Direct Ownership Interest Mar 9, 2007 100%
Mary Jane Herrero Capuz Individual Corporate OfficerActing Chief Financial Officer Jan 1, 2022 40%
Abraham Mora Individual W-2 Managing EmployeeActing Chief Executive Director Aug 26, 2024 40%
Annie M Makepeace Individual Corporate DirectorCHC Board Member Oct 1, 2015 5%

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Northern Region Community Health CenterDededo, GU, CCN 651801 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 9, 2007

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

NPI Registry JSON

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365724800000",
    "number": "1629041546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 ABMAN DRIVE",
            "city": "INARAJAN",
            "state": "GU",
            "postal_code": "969152816",
            "telephone_number": "671-828-7501",
            "fax_number": "671-828-7504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 ABMAN DRIVE",
            "city": "INARAJAN",
            "state": "GU",
            "postal_code": "969152816",
            "telephone_number": "671-828-7501",
            "fax_number": "671-828-7504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-10",
        "last_updated": "2013-04-12",
        "status": "A",
        "authorized_official_last_name": "DENORCEY",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "UNPINGCO",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "671-635-4422",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "GU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Region Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Inarajan, GU

Sources for this page

Verify at the official NPI Registry.