NPIMap

Organization Active NPI

Canyonlands Community Health Care

Doing business as Canyonlands - Mesquite

  • Federally Qualified Health Center (FQHC)
  • Mesquite, NV
National Provider Identifier
1902471303
Registry record updated May 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CANYONLANDS COMMUNITY HEALTH CARE
Doing business as
Canyonlands - Mesquite
Practice address
210 N Sandhill Blvd
Mesquite, NV 89027-4789
Phone
(702) 602-0556
NPI assigned
May 26, 2021
Last updated
May 26, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CANYONLANDS COMMUNITY HEALTH CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 26, 2021

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

Authorized official

Name
Mari A Reed
Title
Director of Operations
Phone
(928) 645-9675

Specialties & licenses 1

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

Addresses

Primary practice location

210 N Sandhill Blvd
Mesquite, NV 89027-4789

Mailing address

PO Box 1625
Page, AZ 86040-1625
Phone (928) 645-9675

Other names 1

  • Canyonlands - Mesquite Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20211021001828 NV Part A Provider - Federally Qualified Health Center (FQHC) 4082509591 Practice locations: Mesquite, NV
O20230911002331 NV Part B Supplier - Clinic/Group Practice 4082509591 Receives reassigned benefits from 3 practitioners
Practice locations: Mesquite, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902471303. Details of each certification follow.

Federally qualified health center certification: CCN 291869

Legal name
CANYONLANDS COMMUNITY HEALTH CARE
Doing business as
CANYONLANDS HEALTHCARE - MESQUITE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 20, 2021
Last certification
Oct 20, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1975 in AZ
Enrollment address
210 N Sandhill Blvd
Mesquite, NV 89027-4789

Other NPIs with the same Medicare PAC ID 10

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

National Provider Directory

National Provider Directory
Tax ID family
Lake Powell Medical Cen15 organizations share this tax ID, including this one
Part of
Lake Powell Medical Cen

Other organizations with this tax ID 14

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

View all 14

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Janice Lovett Individual Corporate Officer Jul 1, 2016 2%
Marcie Larson Individual Corporate Director May 1, 2019 20%
Judith Brittain Individual OtherBoard Member Sep 1, 2023
Holly Smith Individual W-2 Managing EmployeeCfo Jan 1, 2016 5%
William Justice Individual Corporate Director Dec 16, 2016
Christopher Hansen Individual Corporate OfficerCeo Jan 1, 2015 5%
W-2 Managing EmployeeCeo Oct 1, 2015 5%
Operational/Managerial ControlCeo Jan 1, 2015 5%
Thomas Bradley Individual Corporate Director Oct 17, 2009
Tom Maikowski Individual Corporate DirectorVice President Dec 16, 2016 20%
Paulette Leblanc Individual Corporate Director Dec 16, 2016

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": "1621987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621987200000",
    "number": "1902471303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1625",
            "city": "PAGE",
            "state": "AZ",
            "postal_code": "860401625",
            "telephone_number": "928-645-9675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 N SANDHILL BLVD",
            "city": "MESQUITE",
            "state": "NV",
            "postal_code": "890274789",
            "telephone_number": "702-602-0556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYONLANDS COMMUNITY HEALTH CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CANYONLANDS COMMUNITY HEALTH CARE",
        "enumeration_date": "2021-05-26",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A",
        "authorized_official_last_name": "REED",
        "authorized_official_first_name": "MARI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "928-645-9675"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyonlands - Mesquite",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesquite, NV

Sources for this page

Verify at the official NPI Registry.