Provider Demographics
NPI:1720024391
Name:HAWTHORNE HOLDINGS, LLC
Entity Type:Organization
Organization Name:HAWTHORNE HOLDINGS, LLC
Other - Org Name:WHITE BLOSSOM CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-471-0388
Mailing Address - Street 1:1990 FRUITDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2709
Mailing Address - Country:US
Mailing Address - Phone:408-998-8447
Mailing Address - Fax:408-288-9812
Practice Address - Street 1:1990 FRUITDALE AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2709
Practice Address - Country:US
Practice Address - Phone:408-998-8447
Practice Address - Fax:408-288-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000120314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720024391Medicaid
CAZZR55068IMedicaid
CAZZR55068IMedicaid