Provider Demographics
NPI:1376917120
Name:BLIZE HEALTHCARE CALIFORNIA INC.
Entity Type:Organization
Organization Name:BLIZE HEALTHCARE CALIFORNIA INC.
Other - Org Name:BLIZE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:UKEJE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELENDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-552-5493
Mailing Address - Street 1:828 SAN PABLO AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1678
Mailing Address - Country:US
Mailing Address - Phone:855-552-5493
Mailing Address - Fax:
Practice Address - Street 1:828 SAN PABLO AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1678
Practice Address - Country:US
Practice Address - Phone:855-552-5493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001547251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551751Medicare Oscar/Certification