NPIMap

Organization Active NPI

Health and Life Organization, Inc.

Doing business as Sacramento Community Clinic - 55th

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
National Provider Identifier
1508487653
Registry record updated May 31, 2023
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.
Doing business as
Sacramento Community Clinic - 55th
Practice address
7215 55TH St
Sacramento, CA 95823-2659
Phone
(916) 642-1867
Fax
(884) 491-6066
NPI assigned
Apr 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2023

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) 642-1867

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

7215 55TH St
Sacramento, CA 95823-2659

Mailing address

3030 Explorer Dr
Sacramento, CA 95827-2728
Phone (916) 642-1867

Other names 1

  • Sacramento Community Clinic - 55th Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230718003807 CA Part A Provider - Federally Qualified Health Center (FQHC) 1153361886 Practice locations: Sacramento, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508487653. Details of each certification follow.

Federally qualified health center certification: CCN A01176

Legal name
HEALTH AND LIFE ORGANIZATION, INC
Doing business as
SACRAMENTO COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 18, 2023
Last certification
Jul 18, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 23, 2003 in CA
Enrollment address
7215 55TH St
Sacramento, CA 95823-2659

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

7215 55th St
Ste B
Sacramento, CA 95823

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Bruce Her Individual Corporate DirectorDirector Oct 1, 2015
Steven Vang Individual Corporate DirectorDirector Apr 1, 2023
Steven Narine Individual Corporate DirectorDirector May 1, 2022
Albert Moua Individual Corporate OfficerCoo Feb 1, 2011
Jerry Bliatout Individual Corporate OfficerChief Executive Officer Dec 1, 2003 100%
W-2 Managing EmployeeCeo Dec 1, 2003 100%
Anita Charles Individual Corporate DirectorDirector Apr 1, 2015
Sabrina Barnes Individual Corporate DirectorDirector Jul 14, 2007
Sylvia Sanderford Individual Corporate Director Aug 1, 2023
Meneu Yang Individual Corporate Director Dec 18, 2023
Chua Her Individual Corporate DirectorDirector Apr 1, 2014
Mai Vang Individual Corporate DirectorDirector Dec 1, 2022
Thang Yang Individual Corporate DirectorDirector May 1, 2022
Bobby Bliatout Individual Corporate OfficerCfo Jan 27, 2011
Stephen Lakos Individual Corporate DirectorDirector Sep 1, 2007

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sacramento Community Clinic - B. Teri Burns ClinicSacramento, CA, CCN 051958 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 19, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685491200000",
    "number": "1508487653",
    "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",
            "telephone_number": "916-642-1867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7215 55TH ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958232659",
            "telephone_number": "916-642-1867",
            "fax_number": "884-491-6066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH AND LIFE ORGANIZATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-29",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "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": "916-642-1867"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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 - 55th",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.