Provider Demographics
NPI:1558667485
Name:BLIZE HEALTHCARE CALIFORNIA INC.
Entity Type:Organization
Organization Name:BLIZE HEALTHCARE CALIFORNIA INC.
Other - Org Name:BLIZE HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
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:800-343-2549
Mailing Address - Street 1:750 ALFRED NOBEL DR
Mailing Address - Street 2:204
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547
Mailing Address - Country:US
Mailing Address - Phone:800-343-2549
Mailing Address - Fax:866-381-9932
Practice Address - Street 1:750 ALFRED NOBEL DR STE 204
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1836
Practice Address - Country:US
Practice Address - Phone:800-343-2549
Practice Address - Fax:510-263-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001547251E00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059354Medicaid
059354Medicare Oscar/Certification
CA551751Medicaid
CA551751Medicare Oscar/Certification