Provider Demographics
NPI:1073834834
Name:BLOSSMAN HEALTHCARE STAFFING, LLC
Entity Type:Organization
Organization Name:BLOSSMAN HEALTHCARE STAFFING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLOSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-403-9091
Mailing Address - Street 1:1403 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-3826
Mailing Address - Country:US
Mailing Address - Phone:601-403-9081
Mailing Address - Fax:601-403-9082
Practice Address - Street 1:1403 S MAIN ST
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-3826
Practice Address - Country:US
Practice Address - Phone:601-403-9081
Practice Address - Fax:601-403-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care