Healthcare Provider Details

I. General information

NPI: 1245177658
Provider Name (Legal Business Name): PATCHWORK COMMUNITY OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9789 EMERALD PARK DR
ELK GROVE CA
95624-2904
US

IV. Provider business mailing address

9789 EMERALD PARK DR
ELK GROVE CA
95624-2904
US

V. Phone/Fax

Practice location:
  • Phone: 202-375-1955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MAYAA GYASI
Title or Position: CEO
Credential:
Phone: 202-375-1955