WELLSPACE HEALTH NPI 1033295084

NPI Information

NPI: 1033295084
Provider Name: WELLSPACE HEALTH

Former Legal Business Name: STRATEGIES FOR CHANGE

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 05D2203772

Address:
4441 AUBURN BLVD
SUITE E
SACRAMENTO, CA
ZIP 95841
Phone: (916) 473-5764
Get Directions

WELLSPACE HEALTH is a federally qualified health center (fqhc) clinic center in Sacramento, CA. WELLSPACE HEALTH NPI is 1033295084. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Strategies For Change.

The provider's business location address is:

4441 AUBURN BLVD
SUITE E
SACRAMENTO, CA
ZIP 95841-139
Phone: (916) 473-5764
Fax: (916) 473-5766

The provider's authorized official is A. Jonathan Porteus .
The authorized official title is Chief Executive Officer and has the following contact phone number (916) 550-5444.

The CLIA number assigned to this NPI record is 05D2203772 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/31/2006 and was last updated on 2/25/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes
2	251S00000X	Community/Behavioral Health				No
3	251S00000X	Community/Behavioral Health		942600143	CALIFORNIA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	343405000	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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