Provider Demographics
NPI:1083374912
Name:BLOSSOM PERSONAL CARE LLC
Entity Type:Organization
Organization Name:BLOSSOM PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:GABRIELA
Authorized Official - Last Name:PAU VEITIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-241-1761
Mailing Address - Street 1:2810 W CHARLESTON BLVD STE E44
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1921
Mailing Address - Country:US
Mailing Address - Phone:702-241-1761
Mailing Address - Fax:
Practice Address - Street 1:2810 W CHARLESTON BLVD STE E44
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1921
Practice Address - Country:US
Practice Address - Phone:702-241-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty