MEDICARE: BAY NATION HOSPICE 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1649887720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY NATION HOSPICE INC.,

Provider Business Mailing Address
First Line	:	39675 CEDAR BLVD STE 235
Second Line	:
City	:	NEWARK
State	:	CA
Zip	:	94560-5490
Country	:	US
Telephone Number	:	510-789-3866
Fax Number	:	510-573-6642

Provider Business Practice Location Address
First Line	:	39675 CEDAR BLVD STE 235
Second Line	:
City	:	NEWARK
State	:	CA
Zip	:	94560-5490
Country	:	US
Telephone Number	:	510-789-3866
Fax Number	:	510-573-6642

Authorized Official
Title or Position	:	CEO
Name	:	SHANAWAZ SYED
Credential	:	ADMINISTRATOR
Telephone Number	:	510-789-3866

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	09/23/2020

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