1295044832 NPI number — HEALTH AND LIFE ORGANIZATION, INC.

Table of content: (NPI 1295044832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295044832 NPI number — HEALTH AND LIFE ORGANIZATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH AND LIFE ORGANIZATION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SACRAMENTO COMMUNITY CLINIC - ASSEMBLY COURT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295044832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7275 E SOUTHGATE DR
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95823-2628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-428-3788
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5524 ASSEMBLY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823-2625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-642-1867
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BLIATOUT
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
916-428-3788

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1538180245 . This is a "UNSPECIFIED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1699082867 . This is a "NPPES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1740336734 . This is a "MEDICARE ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com