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ELICA HEALTH CENTERS - MACK ROAD
NPI 1154947711
Clinic/Center - Federally Qualified Health Center (FQHC) in Sacramento, CA

Active since June 19, 2020CLIA Certified · 4 labs
6339 MACK RD, SACRAMENTO, CA 95823(916) 454-2345(916) 890-3828 Get Directions Write a Review

NPPES record last updated: March 8, 2022. Verified against the NPPES registry weekly; last sync: September 13, 2026.

Record update history: Mar 8, 2022, Jan 28, 2021, Jun 19, 2020 (3 updates tracked since 2020).

About Elica Health Centers - Mack Road NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ELICA HEALTH CENTERS - MACK ROAD (NPI 1154947711) is a healthcare organization registered as a federally qualified health center (fqhc) in Sacramento, California and active in the NPI registry since June 2020. The organization holds 4 active CLIA laboratory certificates and lists Tatyana Bak, Ceo, as its authorized official.

NPPES Registry Identity

NPI1154947711
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameELICA HEALTH CENTERS
Location Address6339 MACK RDSacramento, CA 95823-4655
Mailing Address1860 Howe Ave Ste 440Sacramento, CA 95825-1098 · (916) 569-8484 · Fax (916) 890-3828
Phone(916) 454-2345
Fax(916) 890-3828
Organization SubpartYes
Authorized OfficialTatyana BakCeo · (916) 569-8484
Enumeration DateJune 19, 2020
Last NPPES UpdateMarch 8, 20223 updates tracked since enumeration
NPPES CertifiedMarch 8, 2022
✔ NPI 1154947711 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedCase Manager/Care CoordinatorTaxonomy 171M00000X
6339 MACK RD, Sacramento, CA 95823
Open in Google Maps ↗

Other Names 1

Other NameElica Health Centers - Mack Road

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 4

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2189007

Elica Health Centers - Mack Road · Sacramento, CA
Active · expires Jul 23, 2028
CLIA Number05D2189007
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateJuly 24, 2026
Certificate Expiration DateJuly 23, 2028
Laboratory DirectorBryan K. Lee
Laboratory Phone(916) 454-2345
Laboratory LocationElica Health Centers - Mack Road6339 Mack Road, Sacramento, CA 95823
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2189802

Elica Health Centers - Cadillac Drive · Sacramento, CA
Active · expires Aug 4, 2028
CLIA Number05D2189802
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateAugust 5, 2026
Certificate Expiration DateAugust 4, 2028
Laboratory DirectorBryan K. Lee
Laboratory Phone(916) 454-2345
Laboratory LocationElica Health Centers - Cadillac Drive77 Cadillac Dr Suite 200, Sacramento, CA 95825
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2180682

Elica Health Centers On Wheels 3 (vin #4uzacmfc8jckg6989) · West Sacramento, CA
Active · expires Mar 17, 2028
CLIA Number05D2180682
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateMarch 18, 2026
Certificate Expiration DateMarch 17, 2028
Laboratory DirectorBryan K. Lee
Laboratory Phone(916) 454-2345
Laboratory LocationElica Health Centers On Wheels 3 (vin #4uzacmfc8jckg6989)1276 Halyard Dr (van #3), West Sacramento, CA 95691
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2280133

Elica Health Centers V Street Medical Center · Sacramento, CA
Active · expires Apr 12, 2027
CLIA Number05D2280133
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateApril 13, 2025
Certificate Expiration DateApril 12, 2027
Laboratory DirectorBryan K. Lee
Laboratory Phone(916) 454-2345
Laboratory LocationElica Health Centers V Street Medical Center923 V Street, Sacramento, CA 95818
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 18

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ADRIENNE EUSEBIO WOLOWODIUK LCSW
Social Worker
6339 MACK RD
SACRAMENTO, CA 95823
Sacramento County (562) 499-6191
DR. TERRENCE PATRICK REIFF D.D.S.
Dentist
6339 MACK RD
SACRAMENTO, CA 95823
Sacramento County (916) 454-2345
DR. CHARLES IVERSON HOOPER D.O.
Family Medicine
6339 MACK RD
SACRAMENTO, CA 95823
Sacramento County (916) 454-2345
DR. ROBERT F DUFRESNE DDS
Dentist
6339 MACK RD
SACRAMENTO, CA 95823
Sacramento County (916) 454-2345
MRS. ASHLEY MARIE ONGJOCO
Nurse Practitioner
6339 MACK RD
SACRAMENTO, CA 95823
Sacramento County (916) 454-2345
JOSEPH M MOLINA MD PROFESSIONAL CORPORATION-SOUTHERN CALIFORNIA
Family Medicine
6339 MACK RD
SACRAMENTO, CA 95823
Sacramento County (916) 585-7912
MANPREET KAUR D.M.D.
Dentist (General Practice)
6339 MACK RD
SACRAMENTO, CA 95823
Sacramento County (916) 454-2345
EDWIN G VENTOCILLA PA-C
Physician Assistant
6339 MACK RD
SACRAMENTO, CA 95823
Sacramento County (916) 454-2345

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Elica Health Centers's NPI number?

The NPI number for Elica Health Centers is 1154947711. It was assigned to this organization in the NPPES registry on June 19, 2020. The provider is also known as Elica Health Centers - Mack Road.

Where is Elica Health Centers located?

Elica Health Centers is located at 6339 Mack Rd, Sacramento, CA 95823. The listed phone number is (916) 454-2345.

What is Elica Health Centers's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Does Elica Health Centers hold CLIA laboratory certificates?

Yes. 4 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Elica Health Centers was last updated on March 8, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.