Organization Active NPI

South-West Community Health Center, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bridgeport, CT
National Provider Identifier
1699703686
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
0032 Issued in CT
Legal business name
SOUTH-WEST COMMUNITY HEALTH CENTER, INC
Practice address
46 Albion St
Bridgeport, CT 06605-2602
Phone
(203) 330-6000
Fax
(203) 330-6008
NPI assigned
Jun 29, 2006
Last updated
Apr 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Authorized official

Name
Mollie Melbourne
Title
President Ceo
Phone
(203) 332-3501

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 0032 CT
Gynecology Physician 207VG0400X 0454 CT
Obstetrics Physician 207VX0000X 0032 CT
Obstetrics Physician 207VX0000X 0454 CT
Federally Qualified Health Center (FQHC) 261QF0400X 0032 CT
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 0032 CT Primary
Primary Care Clinic/Center 261QP2300X 0032 CT
Primary Care Clinic/Center 261QP2300X 0454 CT
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

46 Albion St
Bridgeport, CT 06605-2602

Mailing address

46 Albion St
Bridgeport, CT 06605-2602
Phone (203) 330-6000

Other practice location 1

968 Fairfield Ave
Bridgeport, CT 06605-1116
Phone (203) 332-3535

Other identifiers 3

IdentifierTypeStateIssuer
004236130MedicaidCT
004236148MedicaidCT
004236122MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT11 enrollments

Enrollment records 11

Enrollment IDStateProvider typePAC IDDetails
O20040406001798 CT Part A Provider - Federally Qualified Health Center (FQHC) 2466445200 Practice locations: Bridgeport, CT
O20040420001098 CT Part B Supplier - Clinic/Group Practice 2466445200 Receives reassigned benefits from 134 practitioners
Practice locations: Bridgeport, CT
O20070828000849 CT Part A Provider - Federally Qualified Health Center (FQHC) 2466445200 Practice locations: Bridgeport, CT
O20131231001429 CT Part A Provider - Federally Qualified Health Center (FQHC) 2466445200 Practice locations: Bridgeport, CT
O20140424000129 CT Part A Provider - Federally Qualified Health Center (FQHC) 2466445200 Practice locations: Bridgeport, CT
O20180425000488 CT Part A Provider - Federally Qualified Health Center (FQHC) 2466445200 Practice locations: Bridgeport, CT
O20210506002439 CT Part A Provider - Federally Qualified Health Center (FQHC) 2466445200 Practice locations: Bridgeport, CT
O20220624000418 CT Part A Provider - Federally Qualified Health Center (FQHC) 2466445200 Practice locations: Bridgeport, CT
O20231213001482 CT Part A Provider - Federally Qualified Health Center (FQHC) 2466445200 Practice locations: Bridgeport, CT
O20240814003125 CT Part A Provider - Federally Qualified Health Center (FQHC) 2466445200 Practice locations: Bridgeport, CT
O20250221001818 CT Part A Provider - Federally Qualified Health Center (FQHC) 2466445200 Practice locations: Bridgeport, CT

NPI to CCN mapping 10

The Medicare certification numbers (CCNs) connected to NPI 1699703686. Details of each certification follow.

Federally qualified health center certification: CCN 071828

Legal name
SOUTH-WEST COMMUNITY HEALTH CENTER INC
Doing business as
SOUTHWEST COMMUNITY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 22, 2004
Last certification
Apr 22, 2004
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 22, 1976 in CT
Enrollment address
510 Clinton Ave
Bridgeport, CT 66051701
Related CCNs
071801

Federally qualified health center certification: CCN 071838

Legal name
SOUTH-WEST COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 25, 2008
Last certification
Mar 25, 2008
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 22, 1976 in CT
Enrollment address
968 Fairfield Ave
Bridgeport, CT 66051116

Federally qualified health center certification: CCN 071903

Legal name
SOUTH-WEST COMMUNITY HEALTH CENTER INC
Doing business as
SOUTHWEST COMMUNITY HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 3, 2014
Last certification
Feb 3, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 13, 1977 in CT
Enrollment address
46 Albion St
Bridgeport, CT 66052602

Federally qualified health center certification: CCN 071905

Legal name
SOUTH-WEST COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 28, 2014
Last certification
Apr 28, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 13, 1977 in CT
Enrollment address
1046 Fairfield Ave
Bridgeport, CT 66051116

Federally qualified health center certification: CCN 071937

Legal name
SOUTH-WEST COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 30, 2018
Last certification
Apr 30, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 25, 1976 in CT
Enrollment address
762 Lindley St
Bridgeport, CT 66065046

Federally qualified health center certification: CCN 071953

Legal name
SOUTH-WEST COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 10, 2021
Last certification
May 10, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 25, 1976 in CT
Enrollment address
399 Mill Hill Ave
Bridgeport, CT 66102865

Federally qualified health center certification: CCN 071965

Legal name
SOUTH-WEST COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 23, 2022
Last certification
Jun 23, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 25, 1976 in CT
Enrollment address
509 Park Ave
Bridgeport, CT 66045859

Federally qualified health center certification: CCN 071014

Legal name
SOUTH-WEST COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 6, 2023
Last certification
Dec 6, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 25, 1976 in CT
Enrollment address
52 George E Pipkins Way
Bridgeport, CT 66082425

Federally qualified health center certification: CCN 071027

Legal name
SOUTH-WEST COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 20, 2024
Last certification
Jun 20, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 25, 1976 in CT
Enrollment address
1020 Fairfield Ave
Bridgeport, CT 66051187

Federally qualified health center certification: CCN 071032

Legal name
SOUTH-WEST COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 21, 2025
Last certification
Feb 21, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1406 State Street Ste 221
Bridgeport, CT 66052005

National Provider Directory

National Provider Directory

Locations

1181 Fairfield Ave
Bridgeport, CT 06605
Phone (203) 275-3081

1406 State St
Bridgeport, CT 06605

1406 State St
Ste 221
Bridgeport, CT 06605
Phone 20333060003564

300 Laurel Ave
Bridgeport, CT 06605
Phone (203) 275-4320

510 Clinton Ave
Bridgeport, CT 06605
Phone (203) 366-4000

680 Park Ave
Bridgeport, CT 06604
Phone (203) 576-8090

762 Lindley St
Bridgeport, CT 06606
Phone (203) 576-5131

968 Fairfield Ave
Bridgeport, CT 06605

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Moraima Hernandez Individual Corporate Director Jan 27, 2010
Corporate Director Jul 8, 2008
Corporate DirectorBoard Member Jul 20, 2008
Corporate DirectorBoard Member Jan 22, 2018
Corporate DirectorBoard Member Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate Director Aug 18, 2023
Corporate DirectorBoard Member Oct 29, 2022
Lawrence a Vitulano Individual Corporate Director Jan 27, 2010
Corporate Director Jun 29, 2001
Corporate DirectorBoard Member Jun 29, 2001
Corporate DirectorBoard Member Jan 22, 2018
Corporate DirectorBoard Member Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate DirectorBoard Member Aug 18, 2023
Corporate DirectorBoard Member Oct 29, 2022
Mollie L Melbourne Individual Corporate OfficerPresident/ Ceo Feb 18, 2019
W-2 Managing EmployeePresident/ Ceo Feb 18, 2019
Operational/Managerial ControlPresident/ Ceo Feb 18, 2019
Corporate DirectorPresident / Ceo Feb 18, 2019
Operational/Managerial ControlPresident / Ceo Feb 18, 2019
Contracted Managing EmployeePresident/ Ceo Feb 18, 2019
Corporate OfficerPresident/Ceo Feb 18, 2019
Corporate OfficerPresident/ Ceo Nov 2, 2020
W-2 Managing EmployeePresident/ Ceo Nov 2, 2020
Contracted Managing Employee Mar 22, 2022
Corporate OfficerPresident/Ceo Mar 22, 2022
W-2 Managing Employee Mar 22, 2022
Corporate OfficerPresident/Ceo Aug 18, 2023
W-2 Managing EmployeePresident/ Ceo Aug 18, 2023
Corporate OfficerPresident/ Ceo Oct 29, 2022
W-2 Managing EmployeePresident/ Ceo Oct 29, 2022
Operational/Managerial ControlPresident/Ceo Oct 29, 2022
Contracted Managing EmployeeAd;President/ Ceo Feb 18, 2019
W-2 Managing EmployeeAd;President/ Ceo Feb 18, 2019
Operational/Managerial ControlPresident/Ceo Feb 18, 2019
Annemarie Mangialaschi Individual Corporate Director Jan 27, 2010
Corporate OfficerBoard Member Jul 1, 2006
Corporate DirectorBoard Member Jul 1, 2006
Corporate DirectorBoard Treasurer Aug 3, 1998
Corporate DirectorBoard Treasurer Jan 22, 2018
Corporate DirectorBoard Member Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate DirectorBoard Member Aug 18, 2023
Corporate DirectorBoard Member / Treasurer Oct 29, 2022
Corporate DirectorBoard Member Aug 3, 1998
Milagros Seguinot Individual Corporate Director Jul 18, 2011
Corporate DirectorBoard Vice Chair Jul 18, 2011
Corporate DirectorBoard Vice Chair Jan 22, 2018
Corporate Director Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate DirectorBoard Member Aug 18, 2023
Corporate DirectorBoard Member / Vice Chair Oct 29, 2022
Corporate DirectorBoard Member / Vice Chair Jul 18, 2011
Steven Guss Individual Corporate Director Jul 19, 2014
Corporate DirectorBoard Member Jul 19, 2014
Corporate DirectorBoard Member Jan 22, 2018
Corporate DirectorBoard Member Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate DirectorBoard Member Aug 18, 2023
Corporate DirectorBoard Member Oct 29, 2022
Corporate OfficerBoard Member Jul 19, 2014
Thomas Krause Individual Corporate OfficerCoo Jan 2, 2002
W-2 Managing Employee Jan 2, 2002
Corporate OfficerCoo Jul 25, 2007
Corporate DirectorCoo Jul 25, 2007
W-2 Managing EmployeeCoo Jul 25, 2007
Corporate OfficerCoo Jan 10, 2005
W-2 Managing EmployeeCoo Jan 10, 2005
Operational/Managerial ControlCoo Jan 10, 2005
Corporate OfficerCoo Jan 22, 2018
W-2 Managing EmployeeCoo Jan 22, 2018
Corporate OfficerCoo Nov 2, 2020
W-2 Managing Employee Nov 2, 2020
Corporate OfficerCoo Mar 22, 2022
W-2 Managing EmployeeCoo Mar 22, 2022
Corporate OfficerCoo Aug 18, 2023
W-2 Managing EmployeeCoo Aug 18, 2023
Corporate OfficerCoo Oct 29, 2022
W-2 Managing EmployeeCoo Oct 29, 2022
W-2 Managing EmployeeAd;Coo Jan 2, 2002
Operational/Managerial ControlCoo Jan 2, 2002
Denise Moye Individual Corporate Director Jan 27, 2010
Corporate Director Jul 1, 2006
Corporate DirectorBoard Member Mar 20, 2006
Corporate DirectorBoard Secretary Mar 6, 2006
Corporate DirectorBoard Secretary Jan 22, 2018
Corporate Director Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate DirectorBoard Member Aug 18, 2023
Corporate DirectorBoard Member Oct 29, 2022
Henry Lugo Individual Corporate DirectorBoard Member Nov 14, 2017
Corporate DirectorBoard Member Jan 22, 2018
Corporate DirectorBoard Member Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate DirectorBoard Member Aug 18, 2023
Corporate DirectorBoard Member Oct 29, 2022
Corporate DirectorBoard Member Nov 17, 2024
Dimitri Hrisovulos Individual Corporate Officer Mar 1, 1991
W-2 Managing EmployeeCfo Mar 1, 1991
Corporate OfficerCfo Feb 28, 2008
Corporate DirectorCfo Jul 25, 2007
W-2 Managing EmployeeCfo Feb 28, 2008
Corporate OfficerCfo Jan 22, 2018
W-2 Managing Employee Jan 22, 2018
Corporate OfficerCfo Nov 2, 2020
W-2 Managing Employee Nov 2, 2020
Corporate OfficerCfo Mar 22, 2022
W-2 Managing EmployeeCfo Mar 22, 2022
Corporate OfficerCfo Aug 18, 2023
W-2 Managing EmployeeCfo Aug 18, 2023
Corporate OfficerCfo Oct 29, 2022
W-2 Managing Employee Oct 29, 2022
Corporate OfficerCfo Mar 4, 1991
W-2 Managing EmployeeCfo Mar 4, 1991
Homi Dastoor Individual Corporate Director Mar 25, 2013
Corporate DirectorBoard Member Mar 25, 2013
Corporate DirectorBoard Member Jan 22, 2018
Corporate DirectorBoard Member Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate DirectorBoard Member Aug 18, 2023
Corporate DirectorBoard Member Oct 29, 2022
Chas Sterback Individual Corporate Director Jul 5, 2012
Corporate Director Jul 1, 2012
Corporate DirectorBoard Member Jul 1, 2012
Corporate DirectorBoard Member Jan 22, 2018
Corporate DirectorBoard Member Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate DirectorBoard Member Aug 18, 2023
Corporate DirectorBoard Member Oct 29, 2022
Dewitt R Harmon Individual Corporate Director Mar 11, 2015
Corporate DirectorBoard Member Mar 11, 2015
Corporate DirectorBoard Member Jan 22, 2018
Corporate DirectorBoard Member Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate DirectorBoard Member Aug 18, 2023
Corporate DirectorBoard Member Oct 29, 2022
Karen Wong Individual Corporate DirectorBoard Member Jul 9, 2020
Corporate DirectorBoard Member Oct 29, 2022
Marshall J Touponse Individual Corporate Director Jan 27, 2010
Corporate Director Jul 1, 2006
Corporate DirectorBoard Chairman Aug 27, 1998
Corporate DirectorBoard Chair Jan 22, 2018
Corporate DirectorChairman Board Member Nov 2, 2020
Corporate DirectorChairman Board Member Mar 22, 2022
Corporate DirectorBoard Chairman Aug 18, 2023
Corporate DirectorBoard Member/ Chairman Oct 29, 2022
Corporate DirectorBoard Member / Chairman Aug 27, 1998
Sultan Stack Individual Corporate Director Jul 1, 2009
Corporate Director Sep 14, 2009
Corporate DirectorBoard Member Sep 14, 2009
Corporate DirectorBoard Member Jan 22, 2018
Corporate Director Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate DirectorBoard Member Aug 18, 2023
Corporate DirectorBoard Member Oct 29, 2022
Bruce M McDonald Individual Corporate Director Jul 18, 2011
Corporate DirectorBoard Member Jul 18, 2019
Corporate DirectorBoard Member Jul 18, 2011
Corporate DirectorBoard Member Jan 22, 2018
Corporate DirectorBoard Member Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate DirectorBoard Member Aug 18, 2023
Corporate DirectorBoard Member Oct 29, 2022
Rosa Hernandez Individual Corporate Director Jun 3, 2013
Corporate DirectorBoard Member Jun 3, 2013
Corporate DirectorBoard Member Jan 22, 2018
Corporate Director Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate DirectorBoard Member Aug 18, 2023
Corporate DirectorBoard Member Oct 29, 2022
Margaret M Zayan Individual Corporate Director Jan 27, 2010
Corporate Director Jul 1, 2005
Corporate DirectorBoard Member Apr 25, 2005
Corporate DirectorBoard Member Jan 22, 2018
Corporate DirectorBoard Member Nov 2, 2020
Corporate DirectorBoard Member Mar 22, 2022
Corporate DirectorBoard Member Aug 18, 2023
Corporate DirectorBoard Member Oct 29, 2022
Corporate Director Apr 25, 2005

Practitioners & affiliated clinicians

Practitioners 155

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 155

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1699703686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 ALBION ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066052602",
            "telephone_number": "203-330-6000",
            "fax_number": "203-382-1436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 ALBION ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066052602",
            "telephone_number": "203-330-6000",
            "fax_number": "203-330-6008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "968 Fairfield Ave",
            "address_purpose": "LOCATION",
            "city": "Bridgeport",
            "state": "CT",
            "postal_code": "066051116",
            "country_code": "US",
            "telephone_number": "203-332-3535",
            "fax_number": "203-334-0395",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH-WEST COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "MELBOURNE",
        "authorized_official_first_name": "MOLLIE",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "203-332-3501"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "CT",
            "license": "0032",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "CT",
            "license": "0454",
            "primary": false
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "CT",
            "license": "0032",
            "primary": false
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "CT",
            "license": "0454",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CT",
            "license": "0032",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CT",
            "license": "0032",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CT",
            "license": "0032",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CT",
            "license": "0454",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236130",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236148",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236122",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.