Provider Demographics
NPI:1497291751
Name:BLOSSOM CREEKS ASSISTED LIVING
Entity Type:Organization
Organization Name:BLOSSOM CREEKS ASSISTED LIVING
Other - Org Name:RAJVINDER SAMRA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RAJVINDER
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:SAMRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-598-9515
Mailing Address - Street 1:501 S APRICOT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-6596
Mailing Address - Country:US
Mailing Address - Phone:559-598-9515
Mailing Address - Fax:
Practice Address - Street 1:501 S APRICOT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-6596
Practice Address - Country:US
Practice Address - Phone:559-598-9515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107206795310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility