Organization
ELICA HEALTH CENTERS
Active
Organization
ELICA HEALTH CENTERS
Active
Parent organization
ELICA HEALTH CENTERS
Other names
Elica Health Centers - Marysville
Organization subpart
Yes
Provider details
NPI number
Legal business name
ELICA HEALTH CENTERS
Authorized official
TATYANA BAK (CEO)
(916) 569-8484
Entity
Organization
Contact information
Practice address
3234 MARYSVILLE BLVD, SACRAMENTO, CA 95815-1411
(916) 454-2345
(916) 890-3828
Mailing address
1860 HOWE AVE STE 440, SACRAMENTO, CA 95825-1098
(916) 569-8484
(916) 256-2214
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB101A
MEDICARE PART B
—
Enumeration date
12/12/2016
Last updated
03/08/2022
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