Organization
EMERALD BLOSSOM MANOR, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE VINCENT KILTHAU (LICENSEE)
(669) 234-3344
Entity
Organization
Contact information
Practice address
5301 GERINE BLOSSOM DR, SAN JOSE, CA 95123-2118
(669) 234-3344
(669) 500-7377
Mailing address
5301 GERINE BLOSSOM DR, SAN JOSE, CA 95123-2118
(669) 234-3344
(669) 500-7377
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
01/11/2019
Last updated
01/11/2019
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