NPIMap

Organization Active NPI

Complete Care Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Huntington Park, CA
National Provider Identifier
1689219628
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMPLETE CARE COMMUNITY HEALTH CENTER, INC
Practice address
7301 State St
Huntington Park, CA 90255-5823
Phone
(323) 581-5120
NPI assigned
Nov 13, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

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

Authorized official

Name
Yury Akopyan
Title
Chief Executive Officer
Phone
(310) 730-6362

Specialties & licenses 1

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

Addresses

Primary practice location

7301 State St
Huntington Park, CA 90255-5823

Mailing address

3000 S Robertson Blvd Ste 280
Los Angeles, CA 90034-3144
Phone (310) 730-6362

Other names 1

  • Complete Care Community Health Center - Huntington Park Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201224000229 CA Part A Provider - Federally Qualified Health Center (FQHC) 3779494190 Practice locations: Huntington Park, CA

Federally qualified health center certification: CCN 921925

Legal name
COMPLETE CARE COMMUNITY HEALTH CENTER, INC
Doing business as
COMPLETE CARE COMMUNITY HEALTH CENTER - HUNTINGTON PARK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 10, 2020
Last certification
Dec 10, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 14, 2003 in CA
Enrollment address
7301 State St
Huntington Park, CA 90255-5823

Other NPIs with the same Medicare PAC ID 11

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2182503Complete Care Community Health Center Inc7301 State Street, Huntington Park, CA 90255Certificate of waiverApr 21, 2028

National Provider Directory

National Provider Directory
Tax ID family
Complete Care Community Health Center Inc13 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 13

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

NameRoleSinceShare
Inessa Miretsky Individual Corporate DirectorBoard Member Apr 19, 2020
Yury Akopyan Individual Corporate OfficerCeo Nov 2, 2012
W-2 Managing EmployeeCeo Nov 2, 2012
Dina E Belensky Individual Corporate DirectorBoard Chair Sep 22, 2019
Joyce Reese Individual Corporate DirectorBoard Secretary Mar 2, 2020
Complete Care Community Health Center, Inc Organization, Los Angeles, CA Corporation, Non-profit Operational/Managerial Control Oct 14, 2003
Mariella Menbreno Individual Corporate DirectorBoard Member Nov 17, 2019
Viktoriya Makerova Individual Corporate DirectorBoard Member Sep 22, 2019
Sonia Henriquez Individual Corporate DirectorBoard Member Nov 25, 2018
Anthony L Willis Individual Corporate DirectorBoard Member Sep 22, 2019
Dmitriy Velin Individual Corporate OfficerCfo Sep 1, 2014
Marisol Jimenez Individual Corporate DirectorBoard Member Dec 16, 2018
Ernesto Haro Individual Corporate DirectorBoard Member Jan 14, 2020
Wendy Navarrete Individual Corporate DirectorBoard Member Nov 25, 2018

Owners & managing parties with NPI records 11

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Complete Care Community Health Center - AltadenaPasadena, CA, CCN 751945 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2016
Complete Care Community Health Center - Monterey ParkMonterey Park, CA, CCN 921927 Federally qualified health center Operational/Managerial Control Oct 14, 2003
Complete Care Community Health Center - Monterey ParkMonterey Park, CA, CCN 921928 Federally qualified health center Operational/Managerial Control Oct 14, 2003

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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": "1573603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1689219628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 S ROBERTSON BLVD STE 280",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900343144",
            "telephone_number": "310-730-6362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7301 STATE ST",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902555823",
            "telephone_number": "323-581-5120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE CARE COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-13",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "AKOPYAN",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "310-730-6362"
    },
    "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": "Complete Care Community Health Center - Huntington Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntington Park, CA

Sources for this page

Verify at the official NPI Registry.