Organization
HEALTH AND LIFE ORGANIZATION, INC.
Active
Organization
HEALTH AND LIFE ORGANIZATION, INC.
Active
Other names
Sacramento Community Clinic - Assembly Court
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY T BLIATOUT J.D. (CEO)
(916) 428-3788
Entity
Organization
Contact information
Practice address
5524 ASSEMBLY CT, SACRAMENTO, CA 95823-2625
(916) 642-1867
Mailing address
7275 E SOUTHGATE DR, SUITE 204, SACRAMENTO, CA 95823-2628
(916) 428-3788
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538180245
UNSPECIFIED
CA
01
—
1699082867
NPPES
CA
01
—
1740336734
MEDICARE ID
CA
Enumeration date
09/30/2010
Last updated
04/26/2011
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