Provider Demographics
NPI:1265266688
Name:BLACKHAWK HEALTHCARE INC.
Entity type:Organization
Organization Name:BLACKHAWK HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RISHI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-575-8900
Mailing Address - Street 1:2603 CAMINO RAMON STE 2002167A
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-9126
Mailing Address - Country:US
Mailing Address - Phone:949-285-5434
Mailing Address - Fax:
Practice Address - Street 1:2603 CAMINO RAMON STE 2002167A
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-9126
Practice Address - Country:US
Practice Address - Phone:949-285-5434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health