Provider Demographics
NPI:1043074552
Name:BLOSSOMCARE, LLC
Entity Type:Organization
Organization Name:BLOSSOMCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONYALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-579-8858
Mailing Address - Street 1:14114 MERCEDES
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3041
Mailing Address - Country:US
Mailing Address - Phone:248-579-8858
Mailing Address - Fax:
Practice Address - Street 1:14114 MERCEDES
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3041
Practice Address - Country:US
Practice Address - Phone:248-579-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health