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NPI Code Detail

MEDICARE: BLOSSOM NURSING AND REHAB CENTER, INC.

MEDICARE: BLOSSOM NURSING AND REHAB CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility2209NOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518961473
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLOSSOM NURSING AND REHAB CENTER, INC.
Provider Business Mailing Address
First Line : 109 BLOSSOM LN
Second Line :
City : SALEM
State : OH
Zip : 44460-4284
Country : US
Telephone Number : 330-337-3033
Fax Number : 330-337-0916
Provider Business Practice Location Address
First Line : 109 BLOSSOM LN
Second Line :
City : SALEM
State : OH
Zip : 44460-4284
Country : US
Telephone Number : 330-337-3033
Fax Number : 330-337-0916
Authorized Official
Title or Position : AR MANAGER
Name : ADAM J WHITE
Credential : MBA
Telephone Number : 614-416-2638
Provider Enumeration Date : 06/09/2005
Last Update Date : 08/22/2020

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