Healthcare Provider Details

I. General information

NPI: 1770303042
Provider Name (Legal Business Name): EVENTIDE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5129 LONE TREE WAY
ANTIOCH CA
94531-8484
US

IV. Provider business mailing address

5129 LONE TREE WAY
ANTIOCH CA
94531-8484
US

V. Phone/Fax

Practice location:
  • Phone: 925-478-7670
  • Fax:
Mailing address:
  • Phone: 925-478-7670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: TANNER ROBERT LEISHMAN
Title or Position: PRESIDENT
Credential:
Phone: 925-478-7670