Provider Demographics
NPI:1629226477
Name:BLOSSOM HILL, INC.
Entity Type:Organization
Organization Name:BLOSSOM HILL, INC.
Other - Org Name:HAVEN HILL HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FALINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-892-2042
Mailing Address - Street 1:10983 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-2537
Mailing Address - Country:US
Mailing Address - Phone:440-526-6515
Mailing Address - Fax:440-526-6615
Practice Address - Street 1:4410 OAKES RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-2562
Practice Address - Country:US
Practice Address - Phone:440-526-6515
Practice Address - Fax:440-526-6615
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLOSSOM HILL INC. CENTER RIDGE HOUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-05
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36G182315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0570172Medicaid