NPIMap

Organization Active NPI

East Valley Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • West Covina, CA
National Provider Identifier
1831243625
Registry record updated Feb 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
960000210 Issued in CA
Legal business name
EAST VALLEY COMMUNITY HEALTH CENTER, INC.
Practice address
420 S Glendora Ave
West Covina, CA 91790-3001
Phone
(626) 919-4333
Fax
(626) 919-2084
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2022

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

Authorized official

Name
Ms. Alicia Mardini
Title
Chief Exec. Officer
Phone
(626) 919-4333

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Federally Qualified Health Center (FQHC) 261QF0400X
Federally Qualified Health Center (FQHC) 261QF0400X 960000210 CA Primary

Addresses

Primary practice location

420 S Glendora Ave
West Covina, CA 91790-3001

Mailing address

420 S Glendora Ave
West Covina, CA 91790-3001
Phone (626) 919-4333

Other practice location 1

4368 Santa Anita Ave
El Monte, CA 91731-1606
Phone (626) 919-4333 ext. 2220

Other identifiers 2

IdentifierTypeStateIssuer
FHC12048FMedicaidCA
FHC123048FMedicaidCA

Other names 1

  • East Valley Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031104000109 CA Part A Provider - Federally Qualified Health Center (FQHC) 9234041765 Practice locations: West Covina, CA
O20050425000560 CA Part B Supplier - Clinic/Group Practice 9234041765 Receives reassigned benefits from 66 practitioners
2 other NPIs on this enrollment
Practice locations: Covina, CA; Pomona, CA; West Covina, CA
O20210212001128 CA Part A Provider - Federally Qualified Health Center (FQHC) 9234041765 Practice locations: El Monte, CA

Federally qualified health center certification: CCN 551951

Legal name
EAST VALLEY COMMUNITY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 30, 2004
Last certification
Jan 30, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 16, 1970 in CA
Enrollment address
420 S Glendora Ave
West Covina, CA 91790-3001

Federally qualified health center certification: CCN 921953

Legal name
EAST VALLEY COMMUNITY HEALTH CENTER, INC.
Doing business as
EAST VALLEY COMMUNITY HEALTH CENTER, INC. - POMONA SHELTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 2, 2021
Last certification
Mar 2, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 16, 1970 in CA
Enrollment address
4368 Santa Anita Ave
FL 1
El Monte, CA 91731-1606

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 2

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

National Provider Directory

National Provider Directory

Locations

276 W College St
Covina, CA 91723
Phone (626) 869-2474

Ownership & related parties

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
Francisco J Benavides Individual Corporate OfficerChief Financial Officer Jun 5, 2022
W-2 Managing EmployeeChief Financial Officer Jun 5, 2022
Laura Miranda Individual Corporate DirectorBoard Member Feb 1, 2022
Elisa Jimenez Individual Corporate DirectorBoard Member Sep 1, 2018
Doran Barnes Individual Corporate DirectorBoard Member Sep 24, 2003
Thomas D Allison Individual Corporate DirectorBoard Member Apr 25, 2012
Tony Song Individual Corporate DirectorBoard Member Dec 15, 2005
Corporate DirectorBoard Member Dec 5, 2005
Chinhnam Hathuc Individual Corporate OfficerChief Medical Officer Jul 1, 2014
W-2 Managing EmployeeChief Medical Officer Jul 1, 2014
Areceli Lopez Individual Corporate DirectorBoard Member Sep 1, 2017
Corporate DirectorBoard Member Sep 17, 2017
Alicia Mardini Individual Corporate OfficerChief Executive Officer Jul 1, 1981
W-2 Managing EmployeeChief Executive Officer Jul 1, 1981
Corporate OfficerChief Executive Officer Jul 1, 1983 100%
W-2 Managing EmployeeChief Executive Officer Jul 1, 1983 100%
Robert Beam Individual Corporate DirectorBoard Member Jun 25, 2014
Chalikorn M Chan Individual Corporate DirectorBoard Member Aug 1, 2018
Joe Leal Individual Corporate DirectorBoard Member Jan 1, 2022
Cheryl a Petersen Individual Corporate DirectorChief Financial Officer Aug 6, 2013
W-2 Managing EmployeeChief Financial Officer Aug 6, 2013

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 89

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

View all 89

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644537600000",
    "number": "1831243625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 S GLENDORA AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903001",
            "telephone_number": "626-919-4333",
            "fax_number": "626-919-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S GLENDORA AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903001",
            "telephone_number": "626-919-4333",
            "fax_number": "626-919-2084"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4368 Santa Anita Ave",
            "address_purpose": "LOCATION",
            "city": "El Monte",
            "state": "CA",
            "postal_code": "917311606",
            "country_code": "US",
            "telephone_number": "626-919-4333 x2220",
            "fax_number": "626-919-2084",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAST VALLEY COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A",
        "authorized_official_last_name": "MARDINI",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "CHIEF EXEC. OFFICER",
        "authorized_official_telephone_number": "626-919-4333",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "960000210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC12048F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC123048F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Valley Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Valley Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Covina, CA

Sources for this page

Verify at the official NPI Registry.