Provider Demographics
NPI:1740336734
Name:HEALTH AND LIFE ORGANIZATION, INC
Entity type:Organization
Organization Name:HEALTH AND LIFE ORGANIZATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
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:916-428-3788
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:916-642-1867
Mailing Address - Fax:
Practice Address - Street 1:7275 E SOUTHGATE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2628
Practice Address - Country:US
Practice Address - Phone:916-428-3788
Practice Address - Fax:916-428-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 261QF0400X
CAA73749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty