Southland Integrated Services, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SOUTHLAND INTEGRATED SERVICES, INC.

Doing business as

Integrated Community Services - Westminster

Practice address

14140 Beach Blvd Ste 223
Westminster, CA 92683-4453

Phone

(714) 934-4637

NPI assigned

Jan 3, 2018

Last updated

Mar 5, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tricia Thao Nguyen, M.P.H

Title

Chief Executive Officer

Phone

(714) 620-7007

Specialties & licenses 1

Addresses

Other names 1

• Integrated Community Services - Westminster Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689181331. Details of each certification follow.

• CCN 921056 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 921056

Legal name

INTEGRATED COMMUNITY SERVICES - WESTMINSTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Mar 26, 2018

Last certification

Mar 26, 2018

Ownership / control type

For profit – corporation

Facility address

14140 Beach Blvd, Suite 223
Westminster, CA 92683

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

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520208000000",
    "number": "1689181331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14140 BEACH BLVD STE 223",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926834453",
            "telephone_number": "714-934-4637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14140 BEACH BLVD STE 223",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926834453",
            "telephone_number": "714-934-4637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND INTEGRATED SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-03",
        "last_updated": "2018-03-05",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_middle_name": "THAO",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "714-620-7007",
        "authorized_official_credential": "M.P.H"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrated Community Services - Westminster",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Federally Qualified Health Center (FQHC) in Westminster, CA
• Providers in Westminster, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.