ELICA HEALTH CENTERS (NPI# 1366051120) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366051120 |
| Entity Type | Organization |
| Organization Name | ELICA HEALTH CENTERS |
| Practice Address |
4815 Watt Ave North Highlands CA 95660-5108 |
| Mailing Address |
1860 Howe Ave Ste 440 Sacramento CA 95825-1098 |
| Practice Telephone | 8553542242 |
| Practice Fax Number | 9168903828 |
| Mailing Telephone | 9165698484 |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2020-07-28 |
| Authorized Official Name | TATYANA BAK (CEO) |
| Authorized Official Telephone | 9165698484 |
| Is Organization Subpart | Y |
| Parent Organization Name | ELICA HEALTH CENTERS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Elica Health Centers North Highlands | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265059182 | Elica Health Centers | Clinic/Center | 77 Cadillac Dr Ste 200, Sacramento, CA 95825-8337 | 2020-06-26 |
| 1548705874 | Elica Health Centers | Clinic/Center | 752 Revere St Unit B, Sacramento, CA 95818-2073 | 2016-12-22 |
| 1740660703 | Elica Health Centers | Clinic/Center | 1750 Wright St Ste 1, Sacramento, CA 95825-4041 | 2015-06-04 |
| 1548425853 | Elica Health Centers | Clinic/Center | 155 15th St Ste A, West Sacramento, CA 95691-3737 | 2008-07-25 |
| 1366068553 | Elica Health Centers | Clinic/Center | 1276 Halyard Dr, West Sacramento, CA 95691-3412 | 2020-06-23 |
| 1154947711 | Elica Health Centers | Clinic/Center | 6339 Mack Rd, Sacramento, CA 95823-4655 | 2020-06-19 |
| 1760013494 | Elica Health Centers | Clinic/Center | 1276 Halyard Dr, West Sacramento, CA 95691-3412 | 2020-01-31 |
| 1851893077 | Elica Health Centers | Clinic/Center | 5708 Watt Avenue, North Highlands, CA 95660 | 2018-03-03 |
| 1205341336 | Elica Health Centers | Clinic/Center | 1276 Halyard Dr, West Sacramento, CA 95691-3412 | 2017-12-12 |
| 1730693805 | Elica Health Centers | Clinic/Center | 1276 Halyard Dr, West Sacramento, CA 95691-3412 | 2017-11-27 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ELICA HEALTH CENTERS | 155 15th St, West Sacramento, CA 95691-3737 |
| Street Address |
4815 WATT AVE |
| City | NORTH HIGHLANDS |
| State | CA |
| Zip Code | 95660-5108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679579726 | Alya Zia Ahmad | Pediatrics | 4815 Watt Ave, North Highlands, CA 95660-5108 | 2005-06-23 |
| 1275148769 | Sandra J Lightner | Nurse Practitioner | 4815 Watt Ave, North Highlands, CA 95660-5108 | 2020-09-10 |
| 1649718578 | Moham M Ansari | Dentist | 4815 Watt Ave, North Highlands, CA 95660-5108 | 2017-02-11 |
| 1700967908 | Larisa Anatolyevna Lysak | Nurse Practitioner | 4815 Watt Ave, North Highlands, CA 95660-5108 | 2006-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881198810 | Wyzell Washington | Behavior Technician | 4039 Polk Street #89, North Highlands, CA 95660 | 2018-03-23 |
| 1184147746 | Rosane Jordao | Registered Nurse | 6045 Watt Ave # Wz3e, North Highlands, CA 95660 | 2017-07-25 |
| 1962823435 | Aaron Michael Lowe | Chiropractor | 5400 Watt Ave., North Highlands, CA 95660 | 2013-12-30 |
| 1609157833 | Working Title LLC | Non-emergency Medical Transport (VAN) | 3831 Tavi Ave, North Highlands, CA 95660 | 2011-09-01 |
| 1275795122 | Twin Rivers Unified School District | Local Education Agency (LEA) | 3222 Winona Way, North Highlands, CA 95660 | 2008-07-01 |
| 1295850154 | Vera Bolyshkanov | Dentist | 6137 Watt Ave, Suite 8, North Highlands, CA 95660 | 2007-03-20 |
| 1245304856 | Nourollah Danialypour | General Practice | 5708 Watt Avenue, North Highlands, CA 95660 | 2006-11-17 |
| 1912000571 | Marc Douglas Siemens | Chiropractor | 5705 Marconi Ave, Ste B, Carmichael, CA 95660 | 2006-09-07 |
| 1811004906 | Wendy Walker Godfrey | Social Worker | 3628 Madison Avenue, Suite 7, North Highlands, CA 95660 | 2006-08-24 |
| 1629181045 | Erik Sternad | Marriage & Family Therapist | 4612 Roseville Road, North Highlands, CA 95660 | 2006-08-17 |
| Find all providers in zip 95660 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301921 | Health and Life Organization, Inc. (h.a.l.o.) | Clinic/Center | 4986 Watt Ave Ste D, North Highlands, CA 95660-5182 | 2019-11-20 |
| 1851893077 | Elica Health Centers | Clinic/Center | 5708 Watt Avenue, North Highlands, CA 95660 | 2018-03-03 |
| 1861942849 | Wellspace Health | Clinic/Center | 6015 Watt Ave, #2, North Highlands, CA 95660-4294 | 2016-10-13 |
| 1326175100 | Wellspace Health | Clinic/Center | 6015 Watt Ave, Ste 2, North Highlands, CA 95660-4294 | 2007-02-27 |
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|---|---|---|---|---|
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| 1508465303 | Valley Health Team, Inc | Clinic/Center | 459 W Line St Ste C, Bishop, CA 93514-3333 | 2020-10-22 |
| 1699373209 | Golden Valley Health Center | Clinic/Center | 1524 Mchenry Ave Ste 550, Modesto, CA 95350-4573 | 2020-10-15 |
| 1508464116 | Golden Valley Health Center | Clinic/Center | 1524 Mchenry Ave Ste 560, Modesto, CA 95350-4573 | 2020-10-15 |
| 1134727746 | Golden Valley Health Center | Clinic/Center | 1524 Mchenry Ave Ste 565, Modesto, CA 95350-4500 | 2020-10-15 |
| 1083221451 | Harmony Health Medical Clinic and Family Resource Center | Clinic/Center | 1930 N. Beale Road, Marysville, CA 95901-6915 | 2020-09-29 |
| 1235745928 | Community Medical Centers Inc | Clinic/Center | 747 E Channel St, Stockton, CA 95202-2628 | 2020-09-18 |
| 1760098503 | Chicago Clinica Medica Familiar Operated By Neighborhood Healthcare | Clinic/Center | 4022 Chicago Ave Ste A, Riverside, CA 92507-5340 | 2020-09-17 |
| 1164037149 | Camarena Health | Clinic/Center | 16645 Road 26, Madera, CA 93638-0830 | 2020-09-15 |
| Find all providers with the same taxonomy | ||||
| City | NORTH HIGHLANDS |
| Zip Code | 95660 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.