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TRI-STATE COMMUNITY HEALTHCARE CENTER
NPI 1508379017
Clinic/Center - Federally Qualified Health Center (FQHC) in Adelanto, CA

Active since November 07, 2017CLIA Certified · 8 labs
11499 BARTLETT AVE, ADELANTO, CA 92301(760) 444-4258 Get Directions Write a Review

NPPES record last updated: September 29, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 30, 2025, Jun 24, 2025, Dec 30, 2024 and 8 more (11 updates tracked since 2017).

About Tri-state Community Healthcare Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TRI-STATE COMMUNITY HEALTHCARE CENTER (NPI 1508379017) is a healthcare organization registered as a federally qualified health center (fqhc) in Adelanto, California and active in the NPI registry since November 2017. The organization holds 8 active CLIA laboratory certificates, maintains 9 additional practice locations, and lists Crystale Mineros, Credentialing Manager, as its authorized official.

NPPES Registry Identity

NPI1508379017
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameTRI-STATE COMMUNITY HEALTHCARE CENTER
Location Address11499 BARTLETT AVEAdelanto, CA 92301-1902
Mailing Address1535 E Colorado StGlendale, CA 91205-1513
Phone(760) 444-4258
Organization SubpartYes
Authorized OfficialCrystale MinerosCredentialing Manager · (909) 575-7161
Enumeration DateNovember 7, 2017
Last NPPES UpdateSeptember 29, 202511 updates tracked since enumeration
NPPES CertifiedSeptember 29, 2025
✔ NPI 1508379017 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X
11499 BARTLETT AVE, Adelanto, CA 92301
Open in Google Maps ↗

Secondary Practice Locations 9

Location 111888 Bartlett AveAdelanto, CA 92301-1709 · Phone (760) 530-9944 · Fax (760) 530-9977
Location 26630 Crenshaw BlvdLos Angeles, CA 90043-4102 · Phone (213) 686-1517 · Fax (213) 686-1518
Location 33600 E 1st StLos Angeles, CA 90063-2326 · Phone (323) 694-0911 · Fax (323) 694-0900
Location 4540 N San Jacinto St Ste IHemet, CA 92543-3154 · Phone (951) 651-1006
Location 51532 San Bernardino Ave Ste A2Pomona, CA 91767-3559 · Phone (909) 301-4041 · Fax (909) 301-4042
Location 611273 Laurel Canyon Blvd Ste 2San Fernando, CA 91340-4357 · Phone (818) 853-2220 · Fax (818) 853-2221
Location 71532 San Bernardino Ave Ste B7Pomona, CA 91767-3559 · Phone (909) 301-4041
Location 8540 N San Jacinto St Ste PHemet, CA 92543-3154 · Phone (951) 929-4000 · Fax (951) 929-4100
Location 94137 Verdugo RdLos Angeles, CA 90065-3820 · Phone (323) 344-9255 · Fax (323) 344-8776

CLIA Laboratory Certificates CMS CLIA 8

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2142540

Tri-State Community Healthcare Center · Adelanto, CA
Active · expires Jan 11, 2028
CLIA Number05D2142540
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateJanuary 12, 2026
Certificate Expiration DateJanuary 11, 2028
Laboratory DirectorEdward T. Paget, MD
Laboratory Phone(760) 530-9944
Laboratory LocationTri-State Community Healthcare Center11888 Bartlett Ave, Adelanto, CA 92301
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2335003

Tri-State Community Healthcare Center · Los Angeles, CA
Active · expires Dec 3, 2027
CLIA Number05D2335003
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateDecember 4, 2025
Certificate Expiration DateDecember 3, 2027
Laboratory DirectorJose Luis Perez
Laboratory Phone(213) 686-1517
Laboratory LocationTri-State Community Healthcare Center6630 Crenshaw Blvd, Los Angeles, CA 90043
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2172975

Tri-State Community Healthcare Center · Los Angeles, CA
Active · expires Oct 1, 2027
CLIA Number05D2172975
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateOctober 2, 2025
Certificate Expiration DateOctober 1, 2027
Laboratory DirectorEdward Paget
Laboratory Phone(323) 344-9255
Laboratory LocationTri-State Community Healthcare Center4137 Verdugo Road, Los Angeles, CA 90065
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2285000

Tri-State Community Healthcare Center · San Fernando, CA
Active · expires Jul 2, 2027
CLIA Number05D2285000
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateJuly 3, 2025
Certificate Expiration DateJuly 2, 2027
Laboratory DirectorJose L. Perez
Laboratory Phone(818) 853-2220
Laboratory LocationTri-State Community Healthcare Center11273 Laurel Canyon Blvd Suite 2, San Fernando, CA 91340
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2316911

Tri-State Community Healthcare Center · Los Angeles, CA
Active · expires Jan 13, 2027
CLIA Number05D2316911
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateJanuary 14, 2025
Certificate Expiration DateJanuary 13, 2027
Laboratory DirectorShahram Mirhashemi
Laboratory Phone(323) 694-0911
Laboratory LocationTri-State Community Healthcare Center3600 E 1st St, Los Angeles, CA 90063
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2273167

Tri-State Community Healthcare Center · Pomona, CA
Active · expires Dec 6, 2026
CLIA Number05D2273167
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateDecember 7, 2024
Certificate Expiration DateDecember 6, 2026
Laboratory DirectorShahram S. Mirhashemi
Laboratory Phone(909) 301-4041
Laboratory LocationTri-State Community Healthcare Center1532 San Bernardino Ave Suite B7, Pomona, CA 91767
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AYA ABDELAZIZ
Dentist
11499 BARTLETT AVE
ADELANTO, CA 92301
San Bernardino County (760) 444-4258
JILLIAN KASK ROSS FNP
Nurse Practitioner (Family)
11499 BARTLETT AVE
ADELANTO, CA 92301
San Bernardino County (760) 444-4258
TAYLOR CARTWRIGHT
Physician Assistant (Medical)
11499 BARTLETT AVE
ADELANTO, CA 92301
San Bernardino County (760) 444-4258
SUSAN TANNER APRN
Nurse Practitioner (Family)
11499 BARTLETT AVE
ADELANTO, CA 92301
San Bernardino County (760) 444-4258
DESERT VALLEY MEDICAL GROUP, INC.
Family Medicine
11499 BARTLETT AVE
ADELANTO, CA 92301
San Bernardino County (760) 241-8000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tri-State Community Healthcare Center's NPI number?

The NPI number for Tri-State Community Healthcare Center is 1508379017. It was assigned to this organization in the NPPES registry on November 7, 2017.

Where is Tri-State Community Healthcare Center located?

Tri-State Community Healthcare Center is located at 11499 Bartlett Ave, Adelanto, CA 92301. The listed phone number is (760) 444-4258.

What is Tri-State Community Healthcare Center's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Does Tri-State Community Healthcare Center hold CLIA laboratory certificates?

Yes. 8 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Tri-State Community Healthcare Center was last updated on September 29, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.