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General NPI Number Information
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NPI Number | 1710443320
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Entity Type | Organization
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Legal Business Name | BLOSSOM HAVEN, INC
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Dates
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Enumeration Date | 02/19/2019
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 6618 E HARWOOD AVE
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City | FRESNO
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State | CA
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Zip | 93727-6566
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Country | US
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Telephone | 559-458-1958
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Fax | 559-276-1181
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Provider Business Mailing Address
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Address Line | 6618 E HARWOOD AVE
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City | FRESNO
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State | CA
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Zip | 93727-6566
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Country | US
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Telephone | 559-458-1958
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Fax | 559-276-1181
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. XIAMY LY-YANG
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Credential |
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Telephone | 559-458-1958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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