ELICA HEALTH CENTERS NPI 1346784295

NPI Information

NPI: 1346784295
Provider Name: ELICA HEALTH CENTERS

Other Name: ELICA HEALTH CENTERS - MARYSVILLE

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

Specialization: Federally Qualified Health Center (FQHC)

Address:
3234 MARYSVILLE BLVD
SACRAMENTO, CA
ZIP 95815
Phone: (916) 454-2345
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ELICA HEALTH CENTERS is a federally qualified health center (fqhc) clinic center in Sacramento, CA. ELICA HEALTH CENTERS NPI is 1346784295. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Elica Health Centers - Marysville.

The provider's business location address is:

3234 MARYSVILLE BLVD
SACRAMENTO, CA
ZIP 95815-411
Phone: (916) 454-2345
Fax: (916) 890-3828

The provider's authorized official is Tatyana Bak .
The authorized official title is Ceo and has the following contact phone number (916) 569-8484.

The CLIA number assigned to this NPI record is 05D2162294 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/12/2016 and was last updated on 3/8/2022.

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	171M00000X	Case Manager/Care Coordinator				No
2	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

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	CB101A	OTHER		MEDICARE PART B

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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