NPIMap

Organization Active NPI

East Valley Community Health Center, Inc.

Doing business as East Valley Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Pomona, CA
National Provider Identifier
1649324443
Registry record updated Feb 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
960000806 Issued in CA
Legal business name
EAST VALLEY COMMUNITY HEALTH CENTER, INC.
Doing business as
East Valley Community Health Center
Practice address
1555 S Garey Ave
Pomona, CA 91766-5222
Phone
(909) 620-8088
Fax
(909) 623-4861
NPI assigned
Jan 22, 2007
Last updated
Feb 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2022

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

Authorized official

Name
Ms. Alicia Mardini
Title
Chief Exec. Officer
Phone
(626) 919-4333

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Federally Qualified Health Center (FQHC) 261QF0400X
Federally Qualified Health Center (FQHC) 261QF0400X 960000806 CA Primary

Addresses

Primary practice location

1555 S Garey Ave
Pomona, CA 91766-5222

Mailing address

420 S Glendora Ave
West Covina, CA 91790-3001
Phone (626) 919-4333

Other practice location 1

1400 E Mission Blvd
Pomona, CA 91766-2229
Phone (626) 919-4333

Other practice location 2

2211 N Orange Grove Ave
Pomona, CA 91767-2319
Phone (626) 919-4333

Other identifiers 1

IdentifierTypeStateIssuer
FHC70508FMedicaidCA

Other names 1

  • East Valley Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031218000209 CA Part A Provider - Federally Qualified Health Center (FQHC) 9234041765 Practice locations: Pomona, CA
O20050425000560 CA Part B Supplier - Clinic/Group Practice 9234041765 Receives reassigned benefits from 66 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Covina, CA; Pomona, CA; West Covina, CA
O20210212001268 CA Part A Provider - Federally Qualified Health Center (FQHC) 9234041765 Practice locations: Pomona, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1649324443. Details of each certification follow.

Federally qualified health center certification: CCN 551952

Legal name
EAST VALLEY COMMUNITY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 30, 2004
Last certification
Jan 30, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 16, 1970 in CA
Enrollment address
1555 S Garey Ave
Pomona, CA 91766-5222

Federally qualified health center certification: CCN 921918

Legal name
EAST VALLEY COMMUNITY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 2, 2021
Last certification
Mar 2, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 16, 1970 in CA
Enrollment address
1400 E Mission Blvd
BLDG a, Ste 2
Pomona, CA 91766-2229

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
East Valley Community Health Center Inc16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

4368 Santa Anita Ave
Fl 1
El Monte, CA 91731

17840 Villa Corta St
La Puente, CA 91744
Phone (626) 559-1329

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
Francisco J Benavides Individual Corporate OfficerChief Financial Officer Jun 5, 2022
W-2 Managing EmployeeChief Financial Officer Jun 15, 2022
Elisa Jimenez Individual Corporate DirectorBoard Member Jan 31, 2023
Corporate DirectorBoard Member Sep 1, 2018
Doran Barnes Individual Corporate DirectorBoard Member Sep 24, 2003
Thomas D Allison Individual Corporate DirectorBoard Member Apr 25, 2012
Tony Song Individual Corporate DirectorBoard Member Dec 15, 2005
Corporate DirectorBoard Member Dec 5, 2005
Chinhnam Hathuc Individual Corporate OfficerChief Medical Officer Jul 1, 2014
W-2 Managing EmployeeChief Medical Officer Jul 1, 2014
Areceli Lopez Individual Corporate DirectorBoard Member Jan 31, 2023
Corporate DirectorBoard Member Sep 17, 2017
Alicia Mardini Individual Corporate OfficerChief Executive Officer Jul 1, 1981
W-2 Managing EmployeeChief Executive Officer Jul 1, 1981
Corporate OfficerChief Executive Officer Jul 1, 1983 100%
W-2 Managing EmployeeChief Executive Officer Nov 1, 2012
Robert Beam Individual Corporate DirectorBoard Member Jun 25, 2014
Chalikorn M Chan Individual Corporate DirectorBoard Member Jan 31, 2023
Corporate DirectorBoard Member Aug 1, 2018
Cheryl a Petersen Individual Corporate DirectorChief Financial Officer Aug 6, 2013
W-2 Managing EmployeeChief Financial Officer Aug 6, 2013

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 72

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 72

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644537600000",
    "number": "1649324443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 S GLENDORA AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903001",
            "telephone_number": "626-919-4333",
            "fax_number": "626-919-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 S GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917665222",
            "telephone_number": "909-620-8088",
            "fax_number": "909-623-4861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 E Mission Blvd",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917662229",
            "country_code": "US",
            "telephone_number": "626-919-4333",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2211 N Orange Grove Ave",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917672319",
            "country_code": "US",
            "telephone_number": "626-919-4333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAST VALLEY COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A",
        "authorized_official_last_name": "MARDINI",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "CHIEF EXEC. OFFICER",
        "authorized_official_telephone_number": "626-919-4333",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "960000806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70508F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Valley Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Valley Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.