Provider Demographics
NPI:1407732837
Name:LIFE HOUSE REENTRY
Entity type:Organization
Organization Name:LIFE HOUSE REENTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-816-0640
Mailing Address - Street 1:8399 FOLSOM BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3544
Mailing Address - Country:US
Mailing Address - Phone:855-454-3387
Mailing Address - Fax:
Practice Address - Street 1:8399 FOLSOM BLVD STE 1
Practice Address - Street 2:OFFICE #4014
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3544
Practice Address - Country:US
Practice Address - Phone:855-454-3387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable