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NPI Code Detail

MEDICARE: HEALTH AND LIFE ORGANIZATION, INC

MEDICARE: HEALTH AND LIFE ORGANIZATION, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2261QD0000XDental Clinic/Center
3261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1144600248
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALTH AND LIFE ORGANIZATION, INC
Provider Business Mailing Address
First Line : 3030 EXPLORER DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95827-2728
Country : US
Telephone Number : 916-642-1867
Fax Number :
Provider Business Practice Location Address
First Line : 3030 EXPLORER DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95827-2728
Country : US
Telephone Number : 916-254-5700
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : JERRY T. BLIATOUT
Credential : JD
Telephone Number : 916-642-1867
Provider Enumeration Date : 06/03/2015
Last Update Date : 11/05/2025

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Directions to “HEALTH AND LIFE ORGANIZATION, INC ” Practice Location

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