Provider Demographics
NPI:1609594431
Name:GRASSROOTS HEALTH A SOCIAL PURPOSE CORPORATION
Entity type:Organization
Organization Name:GRASSROOTS HEALTH A SOCIAL PURPOSE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-887-3651
Mailing Address - Street 1:97 DOBBINS ST STE A
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-2700
Mailing Address - Country:US
Mailing Address - Phone:707-887-3651
Mailing Address - Fax:707-210-0480
Practice Address - Street 1:97 DOBBINS ST STE A
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-2700
Practice Address - Country:US
Practice Address - Phone:707-887-3651
Practice Address - Fax:707-210-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251V00000XAgenciesVoluntary or Charitable
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health