Provider Demographics
NPI:1053600841
Name:BLOSSOM VIEW NURSING HOME
Entity type:Organization
Organization Name:BLOSSOM VIEW NURSING HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-483-2000
Mailing Address - Street 1:47 MAPLE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SODUS
Mailing Address - State:NY
Mailing Address - Zip Code:14551-1057
Mailing Address - Country:US
Mailing Address - Phone:315-483-2000
Mailing Address - Fax:315-483-6805
Practice Address - Street 1:47 MAPLE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SODUS
Practice Address - State:NY
Practice Address - Zip Code:14551-1057
Practice Address - Country:US
Practice Address - Phone:315-483-2000
Practice Address - Fax:315-483-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5828301N261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00997604Medicaid
NY5828301NOtherLICENSE
NY335378Medicare Oscar/Certification