Southland Integrated Services, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SOUTHLAND INTEGRATED SERVICES, INC.

Doing business as

Integrated Community Services - Anaheim

Practice address

2035 E Ball Rd Ste 100a
Anaheim, CA 92806-5158

Phone

(714) 517-6150

NPI assigned

Jan 3, 2018

Last updated

Feb 27, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tricia Thao Nguyen, M.P.H.

Title

Chief Executive Officer

Phone

(714) 620-7007

Specialties & licenses 1

Addresses

Other names 1

• Integrated Community Services - Anaheim Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942717699. Details of each certification follow.

• CCN 921055 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 921055

Legal name

INTEGRATED COMMUNITY SERVICES - ANAHEIM

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Mar 26, 2018

Last certification

Mar 26, 2018

Ownership / control type

For profit – corporation

Facility address

2035 East Ball Road, Suite 100a
Anaheim, CA 92806

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

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551225600000",
    "number": "1942717699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2035 E BALL RD",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928065159",
            "telephone_number": "714-517-6150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2035 E BALL RD STE 100A",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928065158",
            "telephone_number": "714-517-6150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND INTEGRATED SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-03",
        "last_updated": "2019-02-27",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_middle_name": "THAO",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "714-620-7007",
        "authorized_official_credential": "M.P.H."
    },
    "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": "Integrated Community Services - Anaheim",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southern California Kaiser Permanente
• Southern California Permanente Medical Group
• Southern Star Home Healthcare, Inc.
• Southland Dental
• Southland Emergency Medical Associates Inc
• K'Ren Spain
• Michele Marie Spainhour, ASW
• Diana Marie Spak, MD
• William J Spak, DPM
• Matthew Michael Spalding

• Federally Qualified Health Center (FQHC) in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.