MEDICARE: BLOSSOM HEALTH CARE 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
1	314000000X	Skilled Nursing Facility	00310389	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1225024474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOM HEALTH CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	989 BLOSSOM RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-2251
Country	:	US
Telephone Number	:	585-482-3500
Fax Number	:	516-809-0161

Provider Business Practice Location Address
First Line	:	989 BLOSSOM RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-2251
Country	:	US
Telephone Number	:	585-482-3500
Fax Number	:	516-809-0161

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GERALD J WOOD
Credential	:
Telephone Number	:	585-482-3500

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	04/20/2008

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