Provider Demographics
NPI:1083398200
Name:BLOSSOM NUTRITION LLC
Entity Type:Organization
Organization Name:BLOSSOM NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEI
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:903-312-4549
Mailing Address - Street 1:904 JULY FOURTH RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-1776
Mailing Address - Country:US
Mailing Address - Phone:903-312-4549
Mailing Address - Fax:
Practice Address - Street 1:904 JULY FOURTH RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-1776
Practice Address - Country:US
Practice Address - Phone:903-312-4549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center