MEDICARE: OLE HEALTH

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
1	261QF0400X	Federally Qualified Health Center (FQHC)	030000771	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710087515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLE HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 1260
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95617-1260
Country	:	US
Telephone Number	:	530-753-3498
Fax Number	:	530-758-2109

Provider Business Practice Location Address
First Line	:	500 B JEFFERSON BLVD
Second Line	:	#180
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95605
Country	:	US
Telephone Number	:	916-375-6400
Fax Number	:	916-375-6413

Authorized Official
Title or Position	:	CFO
Name	:	ROSE MACISAAC
Credential	:
Telephone Number	:	760-767-6435

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	10/17/2023

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Directions to “OLE HEALTH ” Practice Location

Language	Start Address	Practice Location

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