NPIMap

Organization Active NPI

La Red Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Georgetown, DE
National Provider Identifier
1700832185
Registry record updated Sep 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA RED HEALTH CENTER INC
Practice address
21444 Carmean Way
Georgetown, DE 19947-4572
Phone
(302) 855-1233
Fax
(302) 855-1020
NPI assigned
May 26, 2006
Last updated
Sep 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2016

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

Authorized official

Name
Mr. Brian Scott Olson, MBA
Title
Chief Executive Officer
Phone
(302) 855-2020

Specialties & licenses 1

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

Addresses

Primary practice location

21444 Carmean Way
Georgetown, DE 19947-4572

Mailing address

21444 Carmean Way
Georgetown, DE 19947-4572
Phone (302) 855-1233

Other identifiers 1

IdentifierTypeStateIssuer
1000021647MedicaidDE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20070124000666 DE Part A Provider - Federally Qualified Health Center (FQHC) 4789668815 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Georgetown, DE
O20070306000183 DE Part B Supplier - Clinic/Group Practice 4789668815 Receives reassigned benefits from 32 practitioners
7 other NPIs on this enrollment
Practice locations: Georgetown, DE; Seaford, DE; Milford, DE
O20100802000746 DE Part A Provider - Federally Qualified Health Center (FQHC) 4789668815 Practice locations: Georgetown, DE
O20111130000398 DE Part A Provider - Federally Qualified Health Center (FQHC) 4789668815 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seaford, DE

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1700832185. Details of each certification follow.

Federally qualified health center certification: CCN 081808

Legal name
LA RED HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 26, 2007
Last certification
Feb 26, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 2002 in DE
Enrollment address
21444 Carmean Way
Georgetown, DE 19947-4572

Federally qualified health center certification: CCN 081805

Legal name
LA RED HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 6, 2004
Last certification
Jul 6, 2004
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 2002 in DE
Enrollment address
21444 Carmean Way
Georgetown, DE 19947-4572

Federally qualified health center certification: CCN 081812

Legal name
LA RED HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 30, 2011
Last certification
Nov 30, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 2002 in DE
Enrollment address
300 High Street
Seaford, DE 19973-3940

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 7

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

National Provider Directory

National Provider Directory

Locations

1 Sussex Ave
Milford, DE 19963
Phone (302) 327-9219

105B N Front St
Seaford, DE 19973
Phone (302) 629-2459

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Laurie Anderson Individual Corporate Director Aug 21, 2024
Corporate DirectorBoard Member Aug 1, 2024
Corporate DirectorStaff Member Aug 1, 2024
George Walker Individual Corporate DirectorBoard President Feb 8, 2017
Bet K Wong Individual Corporate DirectorBoard Member Mar 1, 2024
Corporate Director Mar 1, 2024
Rony Baltazar Individual Corporate Director Jul 19, 2023
Gertha Jean Individual Corporate DirectorBoard Member Nov 13, 2019
Corporate Director Nov 13, 2019
Tonika L Ward Individual Corporate Director Nov 15, 2023
Tanya Harris Individual Corporate DirectorBoard Vice President Jun 1, 2022
Corporate DirectorBoard Secretary Feb 10, 2021
Velma Norwood Individual Corporate DirectorBoard Member Jun 1, 2022
Corporate DirectorBoard VP Jun 21, 2010
Corporate DirectorBoard VP Nov 14, 2007
Usda Department of Agriculture Rural Development Organization, Dover, DE Created for acquisition 5% Or Greater Mortgage Interest Jul 28, 2002 40%
5% Or Greater Mortgage Interest Jul 28, 2012 40%
Lissette Galloza Individual Corporate DirectorTreasurer Jun 1, 2022
Corporate DirectorBoard Member Nov 13, 2019
Bianca a Mojica Individual Corporate DirectorBoard Member Jul 9, 2014
Judith Johnson Individual Corporate DirectorBoard Member Jun 1, 2022
Corporate DirectorBoard Treasurer Jun 21, 2010
Corporate DirectorBoard Treasurer Oct 8, 2008
Lili Lorena Zunan Individual Corporate DirectorBoard Member Apr 1, 2024
Michael McGroerty Individual Corporate DirectorSecretary Jun 1, 2022
Corporate DirectorBoard Member Dec 11, 2019
Brian S Olson Individual Corporate OfficerCeo Sep 19, 2006
W-2 Managing EmployeeCeo Sep 19, 2006
Corporate OfficerCeo Jun 1, 2010
W-2 Managing Employee Jun 1, 2010 100%
Corporate DirectorCeo Aug 1, 2001 100%
W-2 Managing EmployeeCeo Aug 1, 2001 100%
Jasmine Finley Individual Corporate DirectorCeo/Authorized Official Aug 21, 2024
Corporate DirectorBoard Member Aug 21, 2024
Corporate DirectorStaff Member Aug 1, 2024
Kathleen Russell Individual Corporate DirectorBoard Member Feb 10, 2021

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1700832185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21444 CARMEAN WAY",
            "city": "GEORGETOWN",
            "state": "DE",
            "postal_code": "199474572",
            "telephone_number": "302-855-1233",
            "fax_number": "302-855-2025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21444 CARMEAN WAY",
            "city": "GEORGETOWN",
            "state": "DE",
            "postal_code": "199474572",
            "telephone_number": "302-855-1233",
            "fax_number": "302-855-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA RED HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "302-855-2020",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000021647",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, DE

Sources for this page

Verify at the official NPI Registry.