Healthcare Provider Details

I. General information

NPI: 1215740469
Provider Name (Legal Business Name): GREATER SACRAMENTO URBAN LEAGUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 MARYSVILLE BLVD
SACRAMENTO CA
95838-3738
US

IV. Provider business mailing address

3725 MARYSVILLE BLVD
SACRAMENTO CA
95838-3738
US

V. Phone/Fax

Practice location:
  • Phone: 916-286-8600
  • Fax:
Mailing address:
  • Phone: 916-286-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENNETH BARNES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 916-807-8966