Provider Demographics
NPI:1508284407
Name:HEALTH FOR ALL - ADMINISTRATION
Entity Type:Organization
Organization Name:HEALTH FOR ALL - ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:WIESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-441-2811
Mailing Address - Street 1:420 I STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-2319
Mailing Address - Country:US
Mailing Address - Phone:916-441-2811
Mailing Address - Fax:916-441-2876
Practice Address - Street 1:420 I STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-2319
Practice Address - Country:US
Practice Address - Phone:916-441-2811
Practice Address - Fax:916-441-2876
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH FOR ALL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-29
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)