Healthcare Provider Details

I. General information

NPI: 1013904879
Provider Name (Legal Business Name): BLYTHE VENTURES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3232 E ARTESIA BLVD
LONG BEACH CA
90805-2811
US

IV. Provider business mailing address

3232 E ARTESIA BLVD
LONG BEACH CA
90805-2811
US

V. Phone/Fax

Practice location:
  • Phone: 562-422-9219
  • Fax:
Mailing address:
  • Phone: 562-422-9219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: JOHN BOWEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 562-422-9219