NPIMap

Organization Active NPI

Friends of Family Health Center

  • Federally Qualified Health Center (FQHC)
  • La Habra, CA
National Provider Identifier
1871818138
Registry record updated Apr 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FRIENDS OF FAMILY HEALTH CENTER
Practice address
501 S Idaho St
Suite 100
La Habra, CA 90631-6047
Phone
(562) 690-0400
Fax
(562) 690-3182
NPI assigned
Mar 30, 2010
Last updated
Apr 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2020

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

Authorized official

Name
Mrs. Dawn Ta
Title
Chief Financial Officer
Phone
(562) 690-0400

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 50015 CA
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X A80057 CA
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X G51286 CA
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X A81700 CA
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 20A9142 CA
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X A106562 CA
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 13382 CA
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X 8539 CA

Addresses

Primary practice location

501 S Idaho St
Suite 100
La Habra, CA 90631-6047

Mailing address

501 S Idaho St
Suite 100
La Habra, CA 90631-6047
Phone (562) 690-0400

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20110323000139 CA Part B Supplier - Clinic/Group Practice 7315120730 Receives reassigned benefits from 18 practitioners
6 other NPIs on this enrollment
Practice locations: La Habra, CA; Whittier, CA; Tustin, CA; Ontario, CA; La Puente, CA; Pico Rivera, CA
O20130517000510 CA Part A Provider - Federally Qualified Health Center (FQHC) 7315120730 Practice locations: La Habra, CA
O20220127002838 CA Part A Provider - Federally Qualified Health Center (FQHC) 7315120730 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ontario, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1871818138. Details of each certification follow.

Federally qualified health center certification: CCN 751018

Legal name
FRIENDS OF FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 17, 2013
Last certification
May 17, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 2010 in CA
Enrollment address
501 S Idaho St
Ste 100
La Habra, CA 90631-6047

Federally qualified health center certification: CCN A01043

Legal name
FRIENDS OF FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 27, 2022
Last certification
Jan 27, 2022
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
1129 W 4TH St
Ontario, CA 91762-1703

Other NPIs with the same Medicare PAC ID 4

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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0951686Friends of Family Health Center501 S Idaho St, Ste #190, La Habra, CA 90631Certificate of waiverSep 23, 2026

National Provider Directory

National Provider Directory

Locations

501 S Idaho St
Ste 190
La Habra, CA 90631
Phone (562) 690-0400

13152 Newport Ave
Tustin, CA 92780
Phone (714) 442-4864

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
Kathleen Sauble Individual Corporate DirectorBoard Member Jan 1, 2019 100%
5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%
Maida I Valencia Individual Contracted Managing EmployeeBusiness Billing Manager Jul 1, 2012 100%
Operational/Managerial ControlDirector of Revenue Cycle Oct 1, 2021
David Deleon Individual Corporate DirectorBoard Member Jan 1, 2019 100%
5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%
Mojgan Manshadi Individual Corporate DirectorBoard Member Jan 1, 2019 100%
5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%
Salvador H. Cervantes Individual Corporate DirectorBoard Member Jan 1, 2019 100%
5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%
Amanda Aviles Individual Corporate DirectorBoard Member Feb 13, 2025 100%
Sherleen Thao Le Individual Corporate DirectorBoard Member Feb 13, 2025 100%
Dung Ngoc Tran Individual Corporate OfficerCfo Jul 1, 2012 100%
Corporate OfficerCfo Oct 1, 2021
Friends of Family Health Center Organization, La Habra, CA Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2010 100%
Elizabeth Walker Individual Corporate DirectorBoard Member Jan 1, 2019 100%
5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%
Tyson Shih Individual Corporate DirectorBoard Member Sep 8, 2020 100%
5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%
Bahram Bahremand Individual Corporate OfficerCeo Jul 1, 2012 100%
Corporate OfficerCeo Jan 3, 2022 100%
Robert C. Gire Individual Corporate DirectorBoard Member Jan 1, 2019 100%
5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2021 100%
Corporate DirectorBoard of Director Member Oct 1, 2021 100%

Owners & managing parties with NPI records 5

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
Friends of Family Health CenterTustin, CA, CCN 751818 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2010

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1269907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588118400000",
    "number": "1871818138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S IDAHO ST",
            "address_2": "SUITE 100",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906316047",
            "telephone_number": "562-690-0400",
            "fax_number": "562-690-3182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S IDAHO ST",
            "address_2": "SUITE 100",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906316047",
            "telephone_number": "562-690-0400",
            "fax_number": "562-690-3182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRIENDS OF FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-30",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A",
        "authorized_official_last_name": "TA",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "562-690-0400",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "50015",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A80057",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G51286",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A81700",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "20A9142",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A106562",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "13382",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "8539",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Habra, CA

Sources for this page

Verify at the official NPI Registry.