Organization
HEALTH AND LIFE ORGANIZATION, INC.
Active
Organization
HEALTH AND LIFE ORGANIZATION, INC.
Active
Other names
Sacramento Community Clinic - Southgate Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY T BLIATOUT (CEO)
(916) 428-3788
Entity
Organization
Contact information
Practice address
7275 E SOUTHGATE DR STE 106, SACRAMENTO, CA 95823-2610
(916) 642-1867
Mailing address
3030 EXPLORER DR, SACRAMENTO, CA 95827-2728
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
05/29/2019
Last updated
11/09/2021
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