NPIMap

Ole Health

Organization Active NPI Federally Qualified Health Center (FQHC) · Calistoga, CA

NPI 1760660831 · NPPES record last updated Nov 15, 2019

Key facts

NPI
1760660831
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
License
550000616 (CA)
Legal business name
OLE HEALTH
Practice address
911 Washington St.
Calistoga, CA 94515
Phone
(707) 709-2308
Fax
(707) 251-2988
NPI assigned
Jan 31, 2008
Organization subpart
No

Authorized official

Name
Ms. Alicia Hardy
Title
Chief Executive Officer
Phone
(707) 254-1774

Owned or controlled facilities with NPI records 1

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

  • Ole Health Federally Qualified Health Center (FQHC) · Fairfield, CA · NPI 1316429558
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL

Other NPIs on the same Medicare enrollment 10

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

Other NPIs with the same Medicare PAC ID 12

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

  • Ole Health Federally Qualified Health Center (FQHC) · Fairfield, CA · NPI 1245043165
    Same PAC ID 7315934767
  • Ole Health Federally Qualified Health Center (FQHC) · Saint Helena, CA · NPI 1295913366
    Same PAC ID 7315934767
  • Ole Health Federally Qualified Health Center (FQHC) · Fairfield, CA · NPI 1316429558
    Same PAC ID 7315934767
  • Ole Health Federally Qualified Health Center (FQHC) · Napa, CA · NPI 1447687330
    Same PAC ID 7315934767
  • Ole Health Federally Qualified Health Center (FQHC) · Fairfield, CA · NPI 1497130280
    Same PAC ID 7315934767
  • Ole Health Federally Qualified Health Center (FQHC) · American Canyon, CA · NPI 1508573379
    Same PAC ID 7315934767
  • Ole Health Federally Qualified Health Center (FQHC) · Davis, CA · NPI 1558366823
    Same PAC ID 7315934767
  • Ole Health Federally Qualified Health Center (FQHC) · Woodland, CA · NPI 1558469064
    Same PAC ID 7315934767
  • Ole Health Federally Qualified Health Center (FQHC) · Napa, CA · NPI 1700976503
    Same PAC ID 7315934767
  • Ole Health Federally Qualified Health Center (FQHC) · West Sacramento, CA · NPI 1710087515
    Same PAC ID 7315934767
  • Ole Health Federally Qualified Health Center (FQHC) · West Sacramento, CA · NPI 1881330579
    Same PAC ID 7315934767
  • Ole Health Federally Qualified Health Center (FQHC) · Napa, CA · NPI 1902106198
    Same PAC ID 7315934767

Corporate family (same tax ID) 21

Organizations that report the same tax identification number in the National Provider Directory.

Facilities connected through Provider of Services related, parent or unit certification numbers.

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 33

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CA

Federally qualified health center certification: CCN 051019

Legal name
OLE HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 24, 2005
Last certification
Aug 24, 2005
Ownership / control type
For profit – partnership
Organization structure
Corporation · Non-profit
Incorporated
Oct 19, 1972 in CA
Enrollment address
911 Washington St
Calistoga, CA 94515-1433
Related CCNs
051001

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
Peter Richmond
Individual 		Corporate Director Dec 31, 2018
Madeline Hernandez
Individual 		Corporate Director Dec 31, 2018
Deborah Goodin
Individual 		Corporate Director
Board Member		 Mar 11, 2022
Exa Johanna Moore
Individual 		Corporate Director Dec 31, 2018
Beatrice Labastida
Individual 		Corporate Director Dec 31, 2018
Arthur Roosa
Individual 		Corporate Director Dec 31, 2018
Patricia McFarland
Individual 		Corporate Director Dec 31, 2018
Monin Martin
Individual 		Corporate Director
Board Member		 Mar 11, 2022
Cephas Mugerwa
Individual 		Corporate Director
Board Member		 Mar 11, 2022
Andrew Torge
Individual 		Corporate Officer
Chro		 Apr 13, 2020
Bryan Nazario
Individual 		Corporate Director
Board Member		 Mar 11, 2022
Rosemarie Bautista Macisaac
Individual 		Corporate Officer
Chief Financial Officer		 Jun 5, 2023
W-2 Managing Employee
Chief Financial Officer		 Jun 5, 2023
Alicia F Hardy
Individual 		Corporate Officer
Ceo		 Jan 8, 2018
W-2 Managing Employee Jan 8, 2018

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Ole Health
Fairfield, CA · CCN 921815		 Federally qualified health center Operational/Managerial Control (100%) Sep 14, 2018

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040427001735 CA Part B Supplier - Clinic/Group Practice 7315934767 Receives reassigned benefits from 134 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Napa, CA; Saint Helena, CA; Fairfield, CA; Calistoga, CA; American Canyon, CA
O20050819000493 CA Part a Provider - Federally Qualified Health Center (FQHC) 7315934767 Practice locations: Calistoga, CA

National Provider Directory

Tax ID family
Ole Health (22 organizations share this tax ID)

Locations

911 Washington St
Calistoga, CA 94515
Phone (707) 709-2308

1222 Pine St
Ste A
Saint Helena, CA 94574
Phone (707) 963-0931

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 550000616 CA Yes

Addresses

Primary practice location

911 Washington St.
Calistoga, CA 94515

Mailing address

1141 Pear Tree LN Ste 100
Napa, CA 94558-6485
Phone (707) 254-1770

Other names

  • OLE Health Former legal business name

Other providers in Calistoga, CA

All providers in Calistoga, CA · Federally Qualified Health Center (FQHC) in California

Sources for this page

Verify at the official NPI Registry.