NPIMap

Organization Active NPI

Complete Care Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Vista, CA
National Provider Identifier
1750163846
Registry record updated Oct 16, 2023
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
2023 W Vista Way Ste J
Vista, CA 92083-6030
Phone
(310) 730-6362
NPI assigned
Oct 16, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

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

Authorized official

Name
Yury Akopyan
Title
Ceo
Phone
(310) 730-6362

Specialties & licenses 1

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

Addresses

Primary practice location

2023 W Vista Way Ste J
Vista, CA 92083-6030

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250206003007 CA Part A Provider - Federally Qualified Health Center (FQHC) 3779494190 Practice locations: Vista, CA

Federally qualified health center certification: CCN A01935

Legal name
COMPLETE CARE COMMUNITY HEALTH CENTER, INC
Doing business as
COMPLETE CARE COMMUNITY HEALTH CENTER - VISTA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 6, 2025
Last certification
Feb 6, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
2023 W Vista Way
Ste J
Vista, CA 92083-6030

Other NPIs with the same Medicare PAC ID 11

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

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 12

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

NameRoleSinceShare
Yury Akopyan Individual Corporate OfficerChief Executive Officer Nov 2, 2012
W-2 Managing EmployeeChief Executive Officer Nov 2, 2012
Joyce Reese Individual Corporate DirectorBoard Member Mar 2, 2020
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 OfficerChief Financial Officer Sep 1, 2014
W-2 Managing EmployeeChief Financial Officer Sep 1, 2014
Clarence Thomas Individual Corporate DirectorBoard Member Nov 20, 2022
Marisol Jimenez Individual Corporate DirectorBoard Member Dec 16, 2018
Ernesto Haro Individual Corporate DirectorBoard Member Jan 14, 2020
Shaun Shahbar Individual Corporate DirectorBoard Member Jul 23, 2023
Wendy Navarrete Individual Corporate DirectorBoard Member Nov 17, 2019

All facility ownership & control disclosures 4

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
Complete Care Community Health Center - Huntington ParkHuntington Park, CA, CCN 921925 Federally qualified health center Operational/Managerial Control Oct 14, 2003

Owned or controlled facilities with NPI records 4

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

NPI Registry JSON

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

{
    "created_epoch": "1697414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697414400000",
    "number": "1750163846",
    "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": "2023 W VISTA WAY STE J",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836030",
            "telephone_number": "310-730-6362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE CARE COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-16",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-14",
        "status": "A",
        "authorized_official_last_name": "AKOPYAN",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "CEO",
        "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": []
}

Other providers in Vista, CA

Sources for this page

Verify at the official NPI Registry.