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General NPI Number Information
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NPI Number | 1932240314
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Entity Type | Organization
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Legal Business Name | BLOSSOM HILL CORPORATION
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 100 OAK AVE SW
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City | MONTGOMERY
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State | MN
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Zip | 56069-1243
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Country | US
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Telephone | 507-364-5312
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Fax | 507-364-5908
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Provider Business Mailing Address
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Address Line | 100 OAK AVE SW
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City | MONTGOMERY
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State | MN
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Zip | 56069
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Country | US
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Telephone | 507-364-5312
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Fax | 507-364-5908
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. PAULA MARIE BEULKE
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Credential |
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Telephone | 507-364-5312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 1072346-1-H
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 1044272-1-AFC
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 1072342-1-HCBS
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License Number State | MN
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