TRI-STATE COMMUNITY HEALTHCARE CENTER
Complete NPI Record 1508379017
Clinic/Center - Federally Qualified Health Center (FQHC) in Adelanto, CA
Active since November 07, 2017CLIA Certified · 8 labs
Complete NPI Dataset
This page contains the complete raw NPPES record for Tri-State Community Healthcare Center (NPI 1508379017), a clinic/center organization in Adelanto, CA. All 29 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1508379017 Field 1/29
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/29
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/29
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: TRI-STATE COMMUNITY HEALTHCARE CENTER Field 4/29
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: 1535 E COLORADO ST Field 5/29
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: GLENDALE Field 6/29
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: CA Field 7/29
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 912051513 Field 8/29
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/29
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider First Line Business Practice Location Address: 11499 BARTLETT AVE Field 10/29
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: ADELANTO Field 11/29
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: CA Field 12/29
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 923011902 Field 13/29
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 14/29
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 7604444258 Field 15/29
- The telephone number associated with the location address of the provider being identified.
- Authorized Official Last Name: MINEROS Field 18/29
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: CRYSTALE Field 19/29
- The first name of the authorized official.
- Authorized Official Title or Position: CREDENTIALING MANAGER Field 20/29
- The title or position of the authorized official.
- Authorized Official Telephone Number: 9095757161 Field 21/29
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 261QP2300X Field 22/29
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 23/29
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 261QF0400X Field 24/29
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: Y Field 25/29
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: Y Field 26/29
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Parent Organization LBN: TRI-STATE COMMUNITY HEALTHCARE CENTER Field 27/29
- The Legal Business Name (LBN) of the parent organization, if the provider is a subpart of a larger entity. This field identifies the official registered name of the parent company or organization under which the provider operates.
- Parent Organization TIN: Not available Field 28/29
- The Taxpayer Identification Number (TIN) of the parent organization, provided when the provider is a subpart of a larger entity. This field identifies the federal tax ID used by the parent organization for official and billing purposes.
Secondary Practice Locations 9
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
11888 Bartlett Ave
Location 1/9Adelanto, CA 92301-1709 · Phone (760) 530-9944 · Fax (760) 530-9977
6630 Crenshaw Blvd
Location 2/9Los Angeles, CA 90043-4102 · Phone (213) 686-1517 · Fax (213) 686-1518
3600 E 1st St
Location 3/9Los Angeles, CA 90063-2326 · Phone (323) 694-0911 · Fax (323) 694-0900
540 N San Jacinto St Ste I
Location 4/9Hemet, CA 92543-3154 · Phone (951) 651-1006
1532 San Bernardino Ave Ste A2
Location 5/9Pomona, CA 91767-3559 · Phone (909) 301-4041 · Fax (909) 301-4042
11273 Laurel Canyon Blvd Ste 2
Location 6/9San Fernando, CA 91340-4357 · Phone (818) 853-2220 · Fax (818) 853-2221
1532 San Bernardino Ave Ste B7
Location 7/9Pomona, CA 91767-3559 · Phone (909) 301-4041
540 N San Jacinto St Ste P
Location 8/9Hemet, CA 92543-3154 · Phone (951) 929-4000 · Fax (951) 929-4100
4137 Verdugo Rd
Location 9/9Los Angeles, CA 90065-3820 · Phone (323) 344-9255 · Fax (323) 344-8776
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