BLC Chancellor-Lodi LH, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BLC CHANCELLOR-LODI LH, LLC

Practice address

2220 W Kettleman LN
Lodi, CA 95242-4347

Phone

(209) 367-8870

NPI assigned

Aug 2, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anna Munoz

Title

Assistant Secretary

Phone

(414) 918-5443

Specialties & licenses 1

Addresses

Other names 1

• Brookdale Lodi Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1245060524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2220 W KETTLEMAN LN",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952424347",
            "telephone_number": "209-367-8870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 W KETTLEMAN LN",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952424347",
            "telephone_number": "209-367-8870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLC CHANCELLOR-LODI LH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-02",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "MUNOZ",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "414-918-5443"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale Lodi",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dhawal Bhanushali, PT
• Shivani Bhatt
• Harpreet Bhupal
• Tattiana Rae Blackwell
• Raylene Blandino, P.A.
• Patricia Josephine Block
• Steven Jay Block, M.D.
• Ronald Dean Blount, LEP
• Jennifer Lynne Blume, LMFT
• Taneshia M Bobo

• Assisted Living Facility in Lodi, CA
• Providers in Lodi, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.