| NPI | 1548705874 |
|---|---|
| Other Name | ELICA HEALTH CENTERS - REVERE MEDICAL CENTER |
| Entity Type | Organization |
| Authorized Contact | TATYANA BAK CEO 916-569-8484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2016-12-22 |
| Last Update Date | 2022-03-08 |