EMERALD BLOSSOM MANOR LLC. NPI 1346714425

NPI Information

  • NPI: 1346714425
  • Provider Name: EMERALD BLOSSOM MANOR, LLC.
  • Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
  • Entity Type: Organization
  • Address: 5301 GERINE BLOSSOM DR
    SAN JOSE, CA
    ZIP 95123
  • Phone: (669) 234-3344

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NPI Details

EMERALD BLOSSOM MANOR, LLC. is an intermediate care facility mentally retarded in San Jose, CA. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. EMERALD BLOSSOM MANOR, LLC. NPI is 1346714425. The provider is registered as an organization entity type.

The provider's business location address is:

5301 GERINE BLOSSOM DR
SAN JOSE, CA
ZIP 95123-118
Phone: (669) 234-3344
Fax: (669) 500-7377

The provider's authorized official is Wayne Vincent Kilthau .
The authorized official title is Licensee and has the following contact phone number (669) 234-3344.

The enumeration date for this NPI number is 1/11/2019 and was last updated on 1/11/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1315P00000XIntermediate Care Facility, Intellectual DisabilitiesYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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