| Doctor Name: | MR. NICHOLIS JAY BLUMENBERG |
| NPI Number: | 1356428908 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 8983 |
| Business Practice Address: | 5133 N Blacktail Rd Marana, AZ - 856539089 |
| Business Phone Number: | 5205910257 |
| Business Fax Number: | |
| Mailing Address: | 5133 N Blacktail Rd, MARANA |
| State: | AZ |
| Postal Code: | 856539089 |
| Phone Number: | 5205910257 |
| Fax Number: | |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385HR2055X |
| License Number: | 8983 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | Respite Care, Mental Illness, Child |
| Taxonomy Definition: | A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers. |