Provider Demographics
NPI:1265048771
Name:SHEKINAH HOSPICES HEALTHCARE AGENCY
Entity type:Organization
Organization Name:SHEKINAH HOSPICES HEALTHCARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOLAJI
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:BABATUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:DHA, MS, BSN, RNCPHQ
Authorized Official - Phone:909-231-0098
Mailing Address - Street 1:9612 FOOTHILL BLVD UNIT 10
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3547
Mailing Address - Country:US
Mailing Address - Phone:909-231-0098
Mailing Address - Fax:909-587-2016
Practice Address - Street 1:9612 FOOTHILL BLVD UNIT 10
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3547
Practice Address - Country:US
Practice Address - Phone:909-231-0098
Practice Address - Fax:909-587-2016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEKINAH GLOBAL HEALTHCARE VENTURES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based