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General NPI Number Information
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NPI Number | 1407732837
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Entity Type | Organization
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Legal Business Name | LIFE HOUSE REENTRY
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 12/28/2025
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Provider Practice Location Address
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Address Line | 2020 HURLEY WAY STE 185D
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City | SACRAMENTO
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State | CA
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Zip | 95825-3223
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Country | US
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Telephone | 855-454-3387
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 HURLEY WAY STE 185D
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City | SACRAMENTO
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State | CA
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Zip | 95825-3223
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Country | US
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Telephone | 855-454-3387
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JULIUS JACKSON
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Credential |
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Telephone | 707-816-0640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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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 | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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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 | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #6
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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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Taxonomy #7
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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