Emerald Blossom Manor, LLC.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

EMERALD BLOSSOM MANOR, LLC.

Practice address

5301 Gerine Blossom Dr
San Jose, CA 95123-2118

Phone

(669) 234-3344

Fax

(669) 500-7377

NPI assigned

Jan 11, 2019

Last updated

Jan 11, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Wayne Vincent KilthauNPI 1235593690

Title

Licensee

Phone

(669) 234-3344

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346714425. Details of each certification follow.

• CCN 55G773 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G773

Legal name

EMERALD BLOSSOM MANOR, LLC

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Dec 17, 2018

Last certification

Nov 26, 2025

Beds

6

Ownership / control type

Other (specify)

Facility address

5301 Gerine Blossom Drive
San Jose, CA 95123

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wayne Kilthau

  • Intellectual & Developmental Disabilities Psychologist
  • San Jose, CA
  • NPI 1235593690
  Authorized official Same address or phone

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

{
    "created_epoch": "1547164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547164800000",
    "number": "1346714425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 GERINE BLOSSOM DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951232118",
            "telephone_number": "669-234-3344",
            "fax_number": "669-500-7377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 GERINE BLOSSOM DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951232118",
            "telephone_number": "669-234-3344",
            "fax_number": "669-500-7377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD BLOSSOM MANOR, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-11",
        "last_updated": "2019-01-11",
        "status": "A",
        "authorized_official_last_name": "KILTHAU",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "669-234-3344"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mitra Emami, M.D.
• Emanuel Frank MD, a Professional Corporation
• Jacqueline Maria Emathinger
• Amberlee Rose Emburton
• Esther Chioma Emenalom, MD
• Emerald Key Villa Inc
• Emergency Physicians Associates Overhead Operating Account Dennis Belo (Emergency Physician Associates)
• Emergency Physicians Associates San Jose PC
• Emerging Milestones, Inc.
• Emeritus Home Health Inc

• Intellectual Disabilities Intermediate Care Facility in San Jose, CA
• Providers in San Jose, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.