Healthcare Provider Details

I. General information

NPI: 1386482701
Provider Name (Legal Business Name): CENTRAL VALLEY HOSPICE PALLIATIVE MEDICINE PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 E FIR AVE STE 104
FRESNO CA
93720-3859
US

IV. Provider business mailing address

1077 N WILLOW AVE SUITE 105 PMB 35
FRESNO CA
93611-4415
US

V. Phone/Fax

Practice location:
  • Phone: 559-779-1888
  • Fax:
Mailing address:
  • Phone: 559-779-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNDEEP GRANDHE
Title or Position: CEO/MEDICAL DIRECTOR
Credential: MD, HMDC, FAAHPM
Phone: 559-779-1888