Provider Demographics
NPI:1144600248
Name:HEALTH AND LIFE ORGANIZATION, INC
Entity Type:Organization
Organization Name:HEALTH AND LIFE ORGANIZATION, INC
Other - Org Name:SACRAMENTO COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BLIATOUT
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:916-642-1867
Mailing Address - Street 1:3030 EXPLORER DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2728
Mailing Address - Country:US
Mailing Address - Phone:916-254-5700
Mailing Address - Fax:
Practice Address - Street 1:3030 EXPLORER DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2728
Practice Address - Country:US
Practice Address - Phone:916-254-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH AND LIFE ORGANIZATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-03
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental