NPIMap

Organization Active NPI

Community Health Development, Inc

Doing business as Canyon Health Center

  • Federally Qualified Health Center (FQHC)
  • Camp Wood, TX
National Provider Identifier
1841316288
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
Z00FM205 Issued in TX
Legal business name
COMMUNITY HEALTH DEVELOPMENT, INC
Doing business as
Canyon Health Center
Practice address
700 S Frio
Camp Wood, TX 78833-0455
Phone
(830) 597-6424
Fax
(830) 597-6427
NPI assigned
Mar 21, 2007
Last updated
Mar 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Authorized official

Name
Mrs. Mayela Castanon
Title
Chief Executive Officer
Phone
(830) 278-5604

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Z00FM205 TX Primary

Addresses

Primary practice location

700 S Frio
Camp Wood, TX 78833-0455

Mailing address

908 S Evans St
Uvalde, TX 78801-6034
Phone (830) 278-5604

Other identifiers 2

IdentifierTypeStateIssuer
111438104MedicaidTX
00FM20OtherTXMEDICARE TRAILBLAZER

Other names 1

  • Canyon Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030210000002 TX Part A Provider - Federally Qualified Health Center (FQHC) 3072422740 Practice locations: Camp Wood, TX
O20040317000564 TX Part B Supplier - Clinic/Group Practice 3072422740 Receives reassigned benefits from 20 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Campwood, TX; Leakey, TX; Uvalde, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841316288. Details of each certification follow.

Federally qualified health center certification: CCN 451947

Legal name
COMMUNITY HEALTH DEVELOPMENT, INC.
Doing business as
CANYON HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 25, 2003
Last certification
Feb 25, 2003
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 17, 1983 in TX
Enrollment address
700 Frio St
Camp Wood, TX 78833
Related CCNs
451817

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Our Health9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

200 Evans St
Uvalde, TX 78801
Phone (830) 278-7105

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Nina Martinez Individual Corporate Director Apr 26, 2018
Monica Gonzales Individual Corporate Director Apr 1, 2008
Reyes Lopez Individual Corporate Director Dec 1, 2012
Patricia Garcia Individual Corporate Director Apr 26, 2018
Fidelia Ballesteros Individual Corporate Director May 19, 2016
Mayela Castanon Individual Corporate DirectorChief Executive Officer Nov 30, 2012
W-2 Managing Employee Aug 7, 2000
Delfina Diaz Individual Corporate Director Mar 24, 2015

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 4

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

FacilityTypeRoleSince
Our HealthUvalde, TX, CCN 451817 Federally qualified health center Other May 1, 1983
Center for Community WellnessUvalde, TX, CCN 451078 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 17, 1983
Chdi SBHC UvaldeUvalde, TX, CCN 971027 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 17, 1983
Chdi Ham LaneUvalde, TX, CCN 971082 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 18, 1985

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1841316288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "908 S EVANS ST",
            "city": "UVALDE",
            "state": "TX",
            "postal_code": "788016034",
            "telephone_number": "830-278-5604",
            "fax_number": "830-278-1836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S FRIO",
            "city": "CAMP WOOD",
            "state": "TX",
            "postal_code": "788330455",
            "telephone_number": "830-597-6424",
            "fax_number": "830-597-6427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH DEVELOPMENT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "CASTANON",
        "authorized_official_first_name": "MAYELA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "830-278-5604",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "TX",
            "license": "Z00FM205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111438104",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE TRAILBLAZER",
            "identifier": "00FM20",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Camp Wood, TX

Sources for this page

Verify at the official NPI Registry.