TRI-STATE COMMUNITY HEALTHCARE CENTER (NPI# 1336646397) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336646397 |
| Entity Type | Organization |
| Organization Name | TRI-STATE COMMUNITY HEALTHCARE CENTER |
| Other Organization Name | MOBILE CLINIC |
| Practice Address |
11888 Bartlett Ave Adelanto CA 92301-1709 |
| Mailing Address |
1402 Bailey Ave Needles CA 92363-3104 |
| Practice Telephone | 7603260222 |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2018-04-06 |
| Authorized Official Name | ARAM MANOUKIAN (CEO) |
| Authorized Official Telephone | 7603260222 |
| Is Organization Subpart | Y |
| Parent Organization Name | TRI-STATE COMMUNITY HEALTHCARE CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| MOBILE CLINIC | Other Name - Individual/Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1402 Bailey Ave, Needles, CA 923633104 | 7603260222 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780292839 | Tri-state Community Healthcare Center | Clinic/Center | 11328 Bartlett Ave Ste 3, Adelanto, CA 92301-1913 | 2020-07-15 |
| 1518424274 | Tri-state Community Healthcare Center | Clinic/Center | 1402 Bailey Ave Ste A, Needles, CA 92363-3104 | 2019-02-28 |
| 1841703253 | Tri-state Community Healthcare Center | Clinic/Center | 8700 S Highway 95, Mohave Valley, AZ 86440-8519 | 2017-11-07 |
| 1922356369 | Tri-state Community Healthcare Center | Clinic/Center | 1402 Bailey Ave, Needles, CA 92363-3104 | 2012-08-15 |
| 1699303628 | Tri-state Community Healthcare Center | Clinic/Center | 4137 Verdugo Rd, Los Angeles, CA 90065-3820 | 2020-03-27 |
| 1952966301 | Tri-state Community Healthcare Center | Clinic/Center | 4137 Verdugo Rd, Los Angeles, CA 90065-3820 | 2019-05-01 |
| 1023526084 | Tri-state Community Healthcare Center | Clinic/Center | 540 N San Jacinto St Ste P, Hemet, CA 92543-3154 | 2018-01-11 |
| 1508379017 | Tri-state Community Healthcare Center | Clinic/Center | 11888 Bartlett Ave, Adelanto, CA 92301-1709 | 2017-11-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | TRI-STATE COMMUNITY HEALTHCARE CENTER | 1402 Bailey Avenue, Needles, CA 92363-3104 |
| Street Address |
11888 BARTLETT AVE |
| City | ADELANTO |
| State | CA |
| Zip Code | 92301-1709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649212770 | John D Zipperer Jr. | Internal Medicine | 11888 Bartlett Ave, Adelanto, CA 92301-1709 | 2006-06-12 |
| 1508379017 | Tri-state Community Healthcare Center | Clinic/Center | 11888 Bartlett Ave, Adelanto, CA 92301-1709 | 2017-11-07 |
| 1235166810 | Yasmin Curameng Robles-gray | Nurse Practitioner | 11888 Bartlett Ave, Adelanto, CA 92301-1709 | 2006-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104342609 | Brittney's Non Emergency Services Transportation | Non-emergency Medical Transport (VAN) | 15120 Christopher St, Adelanto, CA 92301 | 2017-08-16 |
| 1285870469 | County of San Bernardino | Public Health or Welfare | 11336 Bartlett Ave #11, Adelanto, CA 92301 | 2008-12-18 |
| 1346323482 | Longs Drug Stores California, LLC | Durable Medical Equipment & Medical Supplies | 12058 Palmdale Rd, Adelanto, CA 92301 | 2006-10-23 |
| 1194142273 | Wal-mart Stores, Inc | Technician/Technologist | 12234 Palmdale Rd, Victorville, CA 92301 | 2014-03-26 |
| 1427435148 | Kay Payton | Driver | 17960 Adelanto Rd, Adelanto, CA 92301-1708 | 2015-05-01 |
| 1295112928 | Emmanuel Unique Outreach Partners | Non-emergency Medical Transport (VAN) | 17960 Adelanto Rd, Adelanto, CA 92301-1708 | 2015-05-01 |
| 1568512176 | Adelanto Esd | Local Education Agency (LEA) | 11824 Air Expy, Adelanto, CA 92301-1730 | 2007-01-12 |
| 1063591139 | Dependable Medical Supply | Durable Medical Equipment & Medical Supplies | 12036 Bartlett Ave, Suite B, Adelanto, CA 92301-1733 | 2006-11-02 |
| 1669737508 | Options Medical Center, Inc | Clinic/Center | 11497 Bartlett Ave Ste B1, Adelanto, CA 92301-1901 | 2012-07-06 |
| 1831368125 | Keana Turner | Durable Medical Equipment & Medical Supplies | 11497 Bartlett Ave Ste B3, Adelanto, CA 92301-1901 | 2008-02-21 |
| Find all providers in zip 92301 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.