Provider Demographics
NPI:1518961473
Name:BLOSSOM NURSING AND REHAB CENTER, INC.
Entity Type:Organization
Organization Name:BLOSSOM NURSING AND REHAB CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:614-416-2638
Mailing Address - Street 1:109 BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-4284
Mailing Address - Country:US
Mailing Address - Phone:330-337-3033
Mailing Address - Fax:330-337-0916
Practice Address - Street 1:109 BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-4284
Practice Address - Country:US
Practice Address - Phone:330-337-3033
Practice Address - Fax:330-337-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2209N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2084168Medicaid
OH366169Medicare ID - Type UnspecifiedPROVIDER NUMBER