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General NPI Number Information
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NPI Number | 1154882082
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Entity Type | Organization
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Legal Business Name | HEALTHY COMMUNITY FORUM FOR THE GREATER SACRAMENTO REGION
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 819 19TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95811-2108
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Country | US
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Telephone | 916-414-8330
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Fax | 916-414-8348
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Provider Business Mailing Address
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Address Line | 819 19TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95811-2108
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Country | US
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Telephone | 916-414-8330
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Fax | 916-414-8348
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. KELLY BENNETT
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Credential |
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Telephone | 916-414-8336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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