Provider Demographics
NPI:1114759057
Name:BLUPEAK HOSPICE LLC
Entity type:Organization
Organization Name:BLUPEAK HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDARAMU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-753-7137
Mailing Address - Street 1:4742 N 24TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-9107
Mailing Address - Country:US
Mailing Address - Phone:602-753-8120
Mailing Address - Fax:
Practice Address - Street 1:4742 N 24TH ST STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-9107
Practice Address - Country:US
Practice Address - Phone:602-753-8120
Practice Address - Fax:602-801-3865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based