Provider Demographics
NPI:1992162119
Name:ROSE BLOSSOM CARE
Entity type:Organization
Organization Name:ROSE BLOSSOM CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MOIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-480-5909
Mailing Address - Street 1:26140 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4100
Mailing Address - Country:US
Mailing Address - Phone:909-480-5909
Mailing Address - Fax:
Practice Address - Street 1:25819 AMAPOLAS ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2503
Practice Address - Country:US
Practice Address - Phone:909-480-5909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care