Provider Demographics
NPI:1588450902
Name:BLOSSOM VALLEY ASSISTED LIVING LLC
Entity type:Organization
Organization Name:BLOSSOM VALLEY ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONINA
Authorized Official - Middle Name:BALAGTAS
Authorized Official - Last Name:FROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-244-2995
Mailing Address - Street 1:5453 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2305
Mailing Address - Country:US
Mailing Address - Phone:520-244-2995
Mailing Address - Fax:520-849-8784
Practice Address - Street 1:5453 E 4TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2305
Practice Address - Country:US
Practice Address - Phone:520-244-2995
Practice Address - Fax:520-849-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility