Provider Demographics
NPI:1992017040
Name:BLOMBORN INC.
Entity type:Organization
Organization Name:BLOMBORN INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BLOMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:435-773-2488
Mailing Address - Street 1:3155 S HIDDEN VALLEY DR
Mailing Address - Street 2:#145
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6671
Mailing Address - Country:US
Mailing Address - Phone:435-773-2488
Mailing Address - Fax:435-773-9925
Practice Address - Street 1:3155 S HIDDEN VALLEY DR
Practice Address - Street 2:#145
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6671
Practice Address - Country:US
Practice Address - Phone:435-773-2488
Practice Address - Fax:435-773-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT15989253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency