Healthcare Provider Details

I. General information

NPI: 1861109274
Provider Name (Legal Business Name): HEALTH AND LIFE ORGANIZATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 55TH ST
SACRAMENTO CA
95823-2659
US

IV. Provider business mailing address

3030 EXPLORER DR
SACRAMENTO CA
95827-2728
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-1867
  • Fax:
Mailing address:
  • Phone: 916-642-1867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ALBERT MOUA
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 916-642-1867