EMERALD BLOSSOM MANOR, LLC. (NPI# 1346714425) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346714425 |
| Entity Type | Organization |
| Organization Name | EMERALD BLOSSOM MANOR, LLC. |
| Practice Address |
5301 Gerine Blossom Dr San Jose CA 95123-2118 |
| Practice Telephone | 6692343344 |
| Practice Fax Number | 6695007377 |
| Mailing Telephone | 6692343344 |
| Mailing Fax Number | 6695007377 |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2019-01-11 |
| Authorized Official Name | WAYNE VINCENT KILTHAU (LICENSEE) |
| Authorized Official Telephone | 6692343344 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| Street Address |
5301 GERINE BLOSSOM DR |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95123-2118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235593690 | Wayne Kilthau | Psychologist | 5301 Gerine Blossom Dr, San Jose, CA 95123-2118 | 2016-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700441045 | Calvin Patrick Nell | Chiropractor | 5570 Sanchez Drive, Ste 100, San Jose, CA 95123 | 2019-05-02 |
| 1629557152 | Jia Tian | Dentist | 393 Blossom Hill Rd Ste 150, San Jose, CA 95123 | 2018-08-06 |
| 1003306176 | Western Dental Services, Inc. | Dentist | 451 Blossom Hill Rd Suite 20, San Jose, CA 95123 | 2018-05-15 |
| 1871004945 | Luxottica of America Inc | Eyewear Supplier (Equipment, not the service) | 5411 Thornwood Dr, San Jose, CA 95123 | 2017-10-17 |
| 1437672953 | Mie Mie Chiu | Dietitian, Registered | 276 Palm Valley Blvd #205, San Jose, CA 95123 | 2017-07-18 |
| 1902335300 | Alfredo Fernandez | Counselor | 5898 Paddon Circle, San Jose, CA 95123 | 2017-06-08 |
| 1780115444 | Christopher Vi Tran | Case Manager/Care Coordinator | 5579 Lean Avenue, San Jose, CA 95123 | 2017-03-24 |
| 1205370004 | Linxi Wu | Acupuncturist | 6064 Cahalan Ave, San Jose, CA 95123 | 2016-12-13 |
| 1013307651 | Kevin Dizon | Dental Hygienist | 6071 Sunstone Drive, San Jose, CA 95123 | 2015-02-04 |
| 1285031294 | Katie Tran | Dental Assistant | 524 Glenburry Way, San Jose, CA 95123 | 2014-11-20 |
| Find all providers in zip 95123 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518390483 | Almond Home II Inc | Intermediate Care Facility, Mentally Retarded | 2551 Gumdrop Dr, San Jose, CA 95148-2019 | 2013-08-15 |
| 1053659086 | Mcr Care Inc. | Intermediate Care Facility, Mentally Retarded | 2223 Golden Dew Cir, San Jose, CA 95121-1441 | 2013-01-25 |
| 1932404555 | Emerald Key Villa Inc | Intermediate Care Facility, Mentally Retarded | 15860 Siesta Vista Drive, San Jose, CA 95127 | 2011-01-12 |
| 1396995072 | Circle of Care Corporation | Intermediate Care Facility, Mentally Retarded | 2130 Turnhouse Lane, San Jose, CA 95121-1377 | 2008-09-30 |
| 1912163031 | Tupaz Home # 14 | Intermediate Care Facility, Mentally Retarded | 14716 Union Ave, San Jose, CA 95124-3574 | 2008-07-29 |
| 1790949303 | Silver Punzalan II Inc | Intermediate Care Facility, Mentally Retarded | 2928 Silver Est, San Jose, CA 95135-1234 | 2008-07-12 |
| 1205019767 | Mouri Management Group Incorporated | Intermediate Care Facility, Mentally Retarded | 2492 Aram Ave, San Jose, CA 95128-4209 | 2007-12-07 |
| 1922219476 | Tupaz Home # 3 | Intermediate Care Facility, Mentally Retarded | 1955 Patio Dr, San Jose, CA 95125-5652 | 2007-05-25 |
| 1518178904 | Tupaz Home # 10 | Intermediate Care Facility, Mentally Retarded | 2893 Ross Ave, San Jose, CA 95124-1848 | 2007-05-25 |
| 1841401213 | Tupaz Home # 7 | Intermediate Care Facility, Mentally Retarded | 308 Marti Way, San Jose, CA 95136-2135 | 2007-05-25 |
| Find all providers in SAN JOSE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.