Provider Demographics
NPI:1346569977
Name:BLOSSOM HEALTH CARE LLC
Entity Type:Organization
Organization Name:BLOSSOM HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:AKINLOSOTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-228-9990
Mailing Address - Street 1:24860 PACIFIC HWY S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24860 PACIFIC HWY S
Practice Address - Street 2:SUITE 102
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5401
Practice Address - Country:US
Practice Address - Phone:253-945-8232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.60141967251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health