Provider Demographics
NPI:1417904228
Name:BLOSSOM 24 HOUR WE CARE CENTER, INC
Entity Type:Organization
Organization Name:BLOSSOM 24 HOUR WE CARE CENTER, INC
Other - Org Name:BLOSSOM/XTRA HELPING HANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DREAMER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-229-3337
Mailing Address - Street 1:11811 SHAKER BLVD
Mailing Address - Street 2:120
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1931
Mailing Address - Country:US
Mailing Address - Phone:216-229-3337
Mailing Address - Fax:216-421-1817
Practice Address - Street 1:11811 SHAKER BLVD
Practice Address - Street 2:120
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1931
Practice Address - Country:US
Practice Address - Phone:216-229-3337
Practice Address - Fax:216-421-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2434397Medicaid