Provider Demographics
NPI:1114641826
Name:BLOSSOM OF HOPE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:BLOSSOM OF HOPE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS CONST
Authorized Official - Prefix:
Authorized Official - First Name:NANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-300-1160
Mailing Address - Street 1:9300 FOREST POINT CIR STE 131
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4743
Mailing Address - Country:US
Mailing Address - Phone:703-479-1117
Mailing Address - Fax:
Practice Address - Street 1:9300 FOREST POINT CIR STE 131
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4743
Practice Address - Country:US
Practice Address - Phone:703-479-1117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care