Provider Demographics
NPI:1164151650
Name:BLOSSOM CARE HEALTH SPECIALIST
Entity Type:Organization
Organization Name:BLOSSOM CARE HEALTH SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINITRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:951-652-0027
Mailing Address - Street 1:1314 W FLORIDA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3995
Mailing Address - Country:US
Mailing Address - Phone:951-652-0027
Mailing Address - Fax:951-652-0690
Practice Address - Street 1:1314 W FLORIDA AVE STE 102
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3995
Practice Address - Country:US
Practice Address - Phone:951-652-0027
Practice Address - Fax:951-652-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health