NPIMap

Organization Active NPI

Greater Prince William Area Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Manassas, VA
National Provider Identifier
1770914939
Registry record updated Jan 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INC
Practice address
9705 Liberia Ave
Manassas, VA 20110-1743
Phone
(703) 680-7950
Fax
(703) 680-7953
NPI assigned
Dec 12, 2013
Organization subpart
Yes
Parent organization
GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 5, 2026

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

Authorized official

Name
Melissa Moorer
Title
Director of Revenue Cycle
Phone
(540) 295-4014

Specialties & licenses 1

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

Addresses

Primary practice location

9705 Liberia Ave
Manassas, VA 20110-1743

Mailing address

3350 Commission CT
Woodbridge, VA 22192-1784
Phone (703) 680-7950

Other identifiers 1

IdentifierTypeStateIssuer
1770914939MedicaidVA

Other names 2

  • Evergreen Terrace Building Doing business as
  • LUNERA HEALTH Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070619000479 VA Part B Supplier - Clinic/Group Practice 9436258209 Receives reassigned benefits from 53 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dumfries, VA; Manassas, VA; Woodbridge, VA
O20140327000698 VA Part A Provider - Federally Qualified Health Center (FQHC) 9436258209 Practice locations: Manassas, VA

Federally qualified health center certification: CCN 491933

Legal name
GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INC
Doing business as
GREATER PRINCE WILLIAM CHC EVERGREEN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 27, 2014
Last certification
Mar 27, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 22, 1978 in VA
Enrollment address
9705 Liberia Avenue
Suite 201
Manassas, VA 20110-1743

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 3

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

National Provider Directory

National Provider Directory
Part of
Greater Prince William Area

Locations

3350 Commission Ct
Woodbridge, VA 22192
Phone (703) 680-7950

3350 Commission Ct
#102
Woodbridge, VA 22192

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
Paul Moessner Individual Corporate Director Feb 25, 2014
Valerie E Keane Individual Corporate Director Feb 25, 2014
David Wilks Individual Corporate Director May 28, 2013
Laura K Posey Individual Corporate Director Feb 25, 2014
Abra Hogarth Individual Corporate Director Feb 25, 2014
Rose Gonzalez Individual Corporate Director May 28, 2013
John Gray Individual Corporate Director Feb 26, 2008
Comfort Mantey Individual Corporate Director Feb 25, 2014
Ron L King Individual Corporate Director Feb 25, 2014
Katty Palomino Individual Corporate Director Feb 25, 2014
William E Harris Individual Corporate Director Oct 25, 2010
Mark Meye Individual Corporate DirectorInterim Ceo Dec 16, 2016
W-2 Managing EmployeeInterim Ceo Dec 16, 2016

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Greater Prince William Community Health CenterManassas, VA, CCN 491044 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 11, 2007

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1386806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767571200000",
    "number": "1770914939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 COMMISSION CT",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221921784",
            "telephone_number": "703-680-7950",
            "fax_number": "703-680-7953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9705 LIBERIA AVE",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201101743",
            "telephone_number": "703-680-7950",
            "fax_number": "703-680-7953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INC",
        "enumeration_date": "2013-12-12",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "status": "A",
        "authorized_official_last_name": "MOORER",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "540-295-4014"
    },
    "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": "1770914939",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Terrace Building",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Evergreen Terrace Building",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LUNERA HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manassas, VA

Sources for this page

Verify at the official NPI Registry.