NPIMap

Organization Active NPI

Friends of Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Tustin, CA
National Provider Identifier
1922489665
Registry record updated Aug 19, 2016
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
13152 Newport Ave
Suite B
Tustin, CA 92780-3469
Phone
(714) 263-8600
Fax
(714) 263-8601
NPI assigned
Jun 17, 2015
Last updated
Aug 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2016

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

13152 Newport Ave
Suite B
Tustin, CA 92780-3469

Mailing address

501 S Idaho St
260
La Habra, CA 90631-6047
Phone (562) 690-0400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

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
This NPI is an additional NPI on the enrollment
Practice locations: La Habra, CA; Whittier, CA; Tustin, CA; Ontario, CA; La Puente, CA; Pico Rivera, CA
O20150924003224 CA Part A Provider - Federally Qualified Health Center (FQHC) 7315120730 Practice locations: Tustin, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922489665. Details of each certification follow.

Federally qualified health center certification: CCN 751818

Legal name
FRIENDS OF FAMILY HEALTH CENTER
Organization structure
CorporationNon-profit
Incorporated
Nov 19, 2013 in CA
Enrollment address
13152 Newport Ave
Tustin, CA 92780-3469

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.

National Provider Directory

National Provider Directory
Tax ID family
Friends of Family Health Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

501 S Idaho St
Ste 260
La Habra, CA 90631
Phone (562) 501-1680

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, 2020 100%
Maida I Valencia Individual Operational/Managerial ControlBusiness Office Manager Sep 1, 2015 100%
David Deleon Individual Corporate DirectorBoard Member Jan 1, 2020 100%
Mojgan Manshadi Individual Corporate DirectorBoard Member Jan 1, 2020 100%
Salvador H. Cervantes Individual Corporate DirectorBoard Member Jan 1, 2020 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 OfficerChief Executive Officer Sep 1, 2015 100%
Friends of Family Health Center Organization, Tustin, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2010 100%
Elizabeth Walker Individual Corporate Director Jan 1, 2020 100%
Tyson Shih Individual Corporate DirectorBoard Member Jan 1, 2020 100%
Bahram Bahremand Individual Corporate OfficerCeo Sep 1, 2015 100%
Robert C. Gire Individual Corporate DirectorBoard Member Jan 1, 2020 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 CenterLa Habra, CA, CCN 751018 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 10

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": "1434499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471564800000",
    "number": "1922489665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S IDAHO ST",
            "address_2": "260",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906316047",
            "telephone_number": "562-690-0400",
            "fax_number": "562-501-1198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13152 NEWPORT AVE",
            "address_2": "SUITE B",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803469",
            "telephone_number": "714-263-8600",
            "fax_number": "714-263-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRIENDS OF FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-17",
        "last_updated": "2016-08-19",
        "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"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.