BLOSSOM RIDGE LONG TERM CARE FACILITY
NPI 1316306970
Skilled Nursing Facility in Elk Grove, CA

Active since February 11, 2016CLIA 05D2110359 · Waiver
10143 BLOSSOM RIDGE DR, ELK GROVE, CA 95757(916) 284-4129(916) 647-3425 Get Directions Write a Review

NPPES record last updated: February 11, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Blossom Ridge Long Term Care Facility NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLOSSOM RIDGE LONG TERM CARE FACILITY (NPI 1316306970) is a healthcare organization registered as a skilled nursing facility in Elk Grove, California and active in the NPI registry since February 2016. The organization holds a CLIA Waiver certificate valid through March 13, 2028 and lists Janet Agustin, Administrator, as its authorized official.

NPPES Registry Identity

NPI1316306970
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameBLOSSOM RIDGE LONG TERM CARE CORPORATION
Location Address10143 BLOSSOM RIDGE DRElk Grove, CA 95757-2512
Mailing Address10143 Blossom Ridge DrElk Grove, CA 95757-2512 · (916) 284-4129 · Fax (916) 647-3425
Fax(916) 647-3425
Organization SubpartNo
Authorized OfficialJanet AgustinAdministrator · (916) 284-4129
Enumeration DateFebruary 11, 2016
NPI 1316306970 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
10143 BLOSSOM RIDGE DR, Elk Grove, CA 95757

Other Names 1

Doing Business AsBlossom Ridge Long Term Care Facility

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2110359

Blossom Ridge Long Term Care Facility · Elk Grove, CA
Active · expires Mar 13, 2028
CLIA Number05D2110359
Laboratory TypeCongre Lvl Hlth Facilty
Certificate Effective DateMarch 14, 2026
Certificate Expiration DateMarch 13, 2028
Laboratory DirectorScarlett Lu, Do
Laboratory Phone(916) 284-4129
Laboratory LocationBlossom Ridge Long Term Care Facility10143 Blossom Ridge Dr, Elk Grove, CA 95757
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blossom Ridge Long Term Care Corporation's NPI number?

The NPI number for Blossom Ridge Long Term Care Corporation is 1316306970. It was assigned to this organization in the NPPES registry on February 11, 2016. The provider is doing business as Blossom Ridge Long Term Care Facility.

Where is Blossom Ridge Long Term Care Corporation located?

Blossom Ridge Long Term Care Corporation is located at 10143 Blossom Ridge Dr, Elk Grove, CA 95757. The listed phone number is (916) 284-4129.

What is Blossom Ridge Long Term Care Corporation's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Blossom Ridge Long Term Care Corporation hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2110359) is associated with this NPI, valid through March 13, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Blossom Ridge Long Term Care Corporation was last updated on February 11, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.