Provider Demographics
NPI:1164043121
Name:CHERRY BLOSSOM SERVICES LLC
Entity Type:Organization
Organization Name:CHERRY BLOSSOM SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO-MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALOHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, CSW
Authorized Official - Phone:973-262-7530
Mailing Address - Street 1:52 HILLSIDE TER
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-1118
Mailing Address - Country:US
Mailing Address - Phone:973-262-7530
Mailing Address - Fax:
Practice Address - Street 1:52 HILLSIDE TER
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1118
Practice Address - Country:US
Practice Address - Phone:973-262-7530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No347C00000XTransportation ServicesPrivate Vehicle