Healthcare Provider Details

I. General information

NPI: 1780360875
Provider Name (Legal Business Name): BLACKHAWK HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 CROW CANYON RD # 160C
SAN RAMON CA
94583-1368
US

IV. Provider business mailing address

3160 CROW CANYON RD # 160C
SAN RAMON CA
94583-1368
US

V. Phone/Fax

Practice location:
  • Phone: 925-575-8900
  • Fax: 925-241-0655
Mailing address:
  • Phone: 925-575-8900
  • Fax: 925-241-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RISHI MEHTA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 925-575-8900