Provider Demographics
NPI:1164722336
Name:BLOSSOM CARE SERVICES INC
Entity Type:Organization
Organization Name:BLOSSOM CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BAVAKAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AVETISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-981-9200
Mailing Address - Street 1:9100 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 217
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1513
Mailing Address - Country:US
Mailing Address - Phone:713-981-9200
Mailing Address - Fax:713-981-9201
Practice Address - Street 1:9100 SOUTHWEST FWY
Practice Address - Street 2:SUITE 217
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1513
Practice Address - Country:US
Practice Address - Phone:713-981-9200
Practice Address - Fax:713-981-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service