Provider Demographics
NPI:1710443320
Name:BLOSSOM HAVEN, INC
Entity type:Organization
Organization Name:BLOSSOM HAVEN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:XIAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LY-YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-458-1958
Mailing Address - Street 1:6618 E HARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-6566
Mailing Address - Country:US
Mailing Address - Phone:559-458-1958
Mailing Address - Fax:559-276-1181
Practice Address - Street 1:6618 E HARWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-6566
Practice Address - Country:US
Practice Address - Phone:559-458-1958
Practice Address - Fax:559-276-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home