NPIMap

Organization Active NPI

La Red Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Georgetown, DE
National Provider Identifier
1811171978
Registry record updated Nov 15, 2013
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
Dec 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2013

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

Authorized official

Name
Mr. Brian S 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
11811171978MedicaidDE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070124000666 DE Part A Provider - Federally Qualified Health Center (FQHC) 4789668815 1 other NPI on this 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
This NPI is an additional NPI on the enrollment
Practice locations: Georgetown, DE; Seaford, DE; Milford, DE

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

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
Tax ID family
La Red Health Care8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 16

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

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384473600000",
    "number": "1811171978",
    "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": "302-855-1020"
        },
        {
            "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": "2007-12-26",
        "last_updated": "2013-11-15",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "S",
        "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": "11811171978",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, DE

Sources for this page

Verify at the official NPI Registry.