NPIMap

Organization Active NPI

Via Care Community Health Center

  • Federally Qualified Health Center (FQHC)
  • South Gate, CA
National Provider Identifier
1962098640
Registry record updated Mar 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VIA CARE COMMUNITY HEALTH CENTER
Practice address
4476 Tweedy Blvd Ste B
South Gate, CA 90280-6359
Phone
(323) 268-9191
NPI assigned
Dec 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2022

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

Authorized official

Name
Vanessa Fuentes
Title
Billing Manager
Phone
(323) 268-9191

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

4476 Tweedy Blvd Ste B
South Gate, CA 90280-6359

Mailing address

501 S Atlantic Blvd
Los Angeles, CA 90022-2621
Phone (323) 268-9191

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230912000327 CA Part A Provider - Federally Qualified Health Center (FQHC) 1052550365 Practice locations: South Gate, CA

Federally qualified health center certification: CCN A01191

Legal name
VIA CARE COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 11, 2023
Last certification
Sep 11, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2020 in CA
Enrollment address
4476 Tweedy Blvd
Ste B
South Gate, CA 90280-6359

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Via Care Community Health Center-Elac Student Health Center25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

Locations

3601 E 1st St
Los Angeles, CA 90063

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Jose Andrade Individual Corporate DirectorBoard Member, Vice Co-Chair Jan 20, 2011
Christina Bugarin Individual Corporate OfficerChief Financial Officer Dec 4, 2017 25%
W-2 Managing EmployeeChief Financial Officer Dec 4, 2017 25%
Fabian Torres Individual Corporate DirectorBoard Member May 27, 2015
Deborah Villar Perez Individual Corporate OfficerChief Executive Officer Apr 26, 2015 25%
W-2 Managing EmployeeChief Executive Officer Apr 26, 2015 25%
Devon Rios Individual Corporate DirectorBoard Member, Vice Co-Chair Jan 23, 2013
Wendy Ruiz Individual Corporate DirectorBoard Member Apr 16, 2014
Armando Lawrence Individual Corporate DirectorBoard Member Jul 16, 2014
Sylvia Villanueva Individual Corporate DirectorBoard Member Jul 1, 2017
John Donner Individual Corporate DirectorBoard Member, Board Chair May 27, 2015
Laura Barrera Individual Corporate DirectorBoard Member Apr 13, 2022
Beatrice Bojorquez Individual Corporate DirectorBoard Member, Secretary Jan 23, 2013

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Via Care Community Health CenterLos Angeles, CA, CCN 751121 Federally qualified health center Operational/Managerial Control (100%) Oct 12, 2010
Via Care Community Health CenterLos Angeles, CA, CCN 921917 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 21, 2015
Via Care Community Health CenterLos Angeles, CA, CCN 921919 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 21, 2015

Owned or controlled facilities with NPI records 3

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

NPI Registry JSON

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

{
    "created_epoch": "1608076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646179200000",
    "number": "1962098640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S ATLANTIC BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900222621",
            "telephone_number": "323-268-9191",
            "fax_number": "323-268-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4476 TWEEDY BLVD STE B",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806359",
            "telephone_number": "323-268-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIA CARE COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-16",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A",
        "authorized_official_last_name": "FUENTES",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "323-268-9191"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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 South Gate, CA

Sources for this page

Verify at the official NPI Registry.