NPIMap

Organization Active NPI

Health and Life Organization, Inc.

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
National Provider Identifier
1104484807
Registry record updated Nov 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEALTH AND LIFE ORGANIZATION, INC.
Practice address
7275 E Southgate Dr Ste 106
Sacramento, CA 95823-2610
Phone
(916) 642-1867
NPI assigned
May 29, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jerry T Bliatout
Title
Ceo
Phone
(916) 428-3788

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

7275 E Southgate Dr Ste 106
Sacramento, CA 95823-2610

Mailing address

3030 Explorer Dr
Sacramento, CA 95827-2728

Other names 1

  • Sacramento Community Clinic - Southgate Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sacramento Community Clinic11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636416000000",
    "number": "1104484807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 EXPLORER DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7275 E SOUTHGATE DR STE 106",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958232610",
            "telephone_number": "916-642-1867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH AND LIFE ORGANIZATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-29",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A",
        "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"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sacramento Community Clinic - Southgate Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.