Thank you for your interest in becoming a Community-Based Care Management Entity (CB-CME) with L.A. Care's Health Homes Program. To become a CB-CME, your organization must be one of the following: Behavioral health entity Community health center Community mental health center Federally qualified health center Hospital or hospital-based physician group or clinic Indian health center Indian health clinic Local health department Primary care provider (PCP) or specialist physician or physician group Provider serving individuals experiencing homelessness Rural health center Substance Use Disorder (SUD) treatment provider Other entities that meet certification Organization Name Point of Contact Full Name Point of Contact Phone Number Type - Type -HomeOfficeCell Phone Ext: Point of Contact Email Address Legal Entity Name (as it appears on W-9) Tax Identification Number (TIN) National Provider Identification (NPI) Organization website Type of Organization - None -Specialty mental health, behavioral health, or substance use treatment centerCommunity health center, FQHC, rural health center, or indian health clinic/centerHospital or hospital-based physician groupCommunity based primary care or specialty physicianLocal government entity Other entity (e.g., community based social service organization, homeless service provider; please describe) Specialty Type & Services (Check all that apply) Primary Care Specialty Care Mental Health Substance Use Disorder CBAS MSSP Other CAPTCHA Submit