NPIMap

Organization Active NPI

Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1952966301
Registry record updated Apr 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRI-STATE COMMUNITY HEALTHCARE CENTER
Practice address
4137 Verdugo Rd
Los Angeles, CA 90065-3820
Phone
(323) 928-5052
NPI assigned
May 1, 2019
Last updated
Apr 30, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
TRI-STATE COMMUNITY HEALTHCARE CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 30, 2021

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

Authorized official

Name
Crystale Mineros
Title
Managed Care Director
Phone
(323) 297-0884

Specialties & licenses 1

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

Addresses

Primary practice location

4137 Verdugo Rd
Los Angeles, CA 90065-3820

Mailing address

4137 Verdugo Rd
Los Angeles, CA 90065-3820

National Provider Directory

National Provider Directory
Tax ID family
Tri-State Comm Hlthcare Ctr12 organizations share this tax ID, including this one
Part of
Tri-State Comm Hlthcare Ctr

Other organizations with this tax ID 11

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1556668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619740800000",
    "number": "1952966301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4137 VERDUGO RD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900653820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4137 VERDUGO RD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900653820",
            "telephone_number": "323-928-5052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE COMMUNITY HEALTHCARE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRI-STATE COMMUNITY HEALTHCARE CENTER",
        "enumeration_date": "2019-05-01",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A",
        "authorized_official_last_name": "MINEROS",
        "authorized_official_first_name": "CRYSTALE",
        "authorized_official_title_or_position": "MANAGED CARE DIRECTOR",
        "authorized_official_telephone_number": "323-297-0884"
    },
    "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 Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.