Blossom Ridge Long Term Care Corporation

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BLOSSOM RIDGE LONG TERM CARE CORPORATION

Practice address

10143 Blossom Ridge Dr
Elk Grove, CA 95757-2512

Phone

(916) 284-4129

Fax

(916) 647-3425

NPI assigned

Feb 11, 2016

Organization subpart

No

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

Authorized official

Name

Janet Agustin

Title

Administrator

Phone

(916) 284-4129

Specialties & licenses 1

Addresses

Other names 1

• Blossom Ridge Long Term Care Facility 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": "1455148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455148800000",
    "number": "1316306970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10143 BLOSSOM RIDGE DR",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957572512",
            "telephone_number": "916-284-4129",
            "fax_number": "916-647-3425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10143 BLOSSOM RIDGE DR",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957572512",
            "telephone_number": "916-284-4129",
            "fax_number": "916-647-3425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM RIDGE LONG TERM CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-11",
        "last_updated": "2016-02-11",
        "status": "A",
        "authorized_official_last_name": "AGUSTIN",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "916-284-4129"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blossom Ridge Long Term Care Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Elk Grove, CA
• Providers in Elk Grove, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2016; 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.