MEDICARE: BLACKHAWK HEALTHCARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1265266688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACKHAWK HEALTHCARE INC.

Provider Business Mailing Address
First Line	:	3160 CROW CANYON RD # 160B
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1368
Country	:	US
Telephone Number	:	949-285-5434
Fax Number	:	925-241-0655

Provider Business Practice Location Address
First Line	:	3160 CROW CANYON RD # 160B
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1368
Country	:	US
Telephone Number	:	949-285-5434
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RISHI MEHTA
Credential	:
Telephone Number	:	925-575-8900

Provider Enumeration Date	:	08/28/2024
Last Update Date	:	12/16/2025

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