Provider Demographics
NPI:1609085844
Name:BLOSSOM HILL INC.
Entity Type:Organization
Organization Name:BLOSSOM HILL INC.
Other - Org Name:CENTER RIDGE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:URBANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-892-2042
Mailing Address - Street 1:28700 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5213
Mailing Address - Country:US
Mailing Address - Phone:440-892-2042
Mailing Address - Fax:440-892-7768
Practice Address - Street 1:28700 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5213
Practice Address - Country:US
Practice Address - Phone:440-892-2042
Practice Address - Fax:440-892-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36G322315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities