Provider Demographics
NPI:1467450528
Name:BNCC, INC.
Entity Type:Organization
Organization Name:BNCC, INC.
Other - Org Name:BLYTHE NURSING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLESSING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:760-533-6763
Mailing Address - Street 1:4022 VIA DE LA PAZ
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-7335
Mailing Address - Country:US
Mailing Address - Phone:760-533-6763
Mailing Address - Fax:760-439-5423
Practice Address - Street 1:285 W CHANSLOR WAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1246
Practice Address - Country:US
Practice Address - Phone:760-922-8176
Practice Address - Fax:760-922-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC90055IMedicaid
CA555383Medicare Oscar/Certification