Provider Demographics
NPI:1386482701
Name:CENTRAL VALLEY HOSPICE PALLIATIVE MEDICINE PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:CENTRAL VALLEY HOSPICE PALLIATIVE MEDICINE PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, HMDC, FAAHPM
Authorized Official - Phone:559-779-1888
Mailing Address - Street 1:1077 N WILLOW AVE SUITE 105
Mailing Address - Street 2:PMB 35
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4415
Mailing Address - Country:US
Mailing Address - Phone:559-779-1888
Mailing Address - Fax:
Practice Address - Street 1:1805 E FIR AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3859
Practice Address - Country:US
Practice Address - Phone:559-779-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient