Provider Demographics
NPI:1457497232
Name:BLOSSOM GROUPS CORPORATION
Entity Type:Organization
Organization Name:BLOSSOM GROUPS CORPORATION
Other - Org Name:BLOSSOM HOME HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:UKACHI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKOGU
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:469-906-6359
Mailing Address - Street 1:12959 JUPITER RD
Mailing Address - Street 2:#253
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-5223
Mailing Address - Country:US
Mailing Address - Phone:469-906-6359
Mailing Address - Fax:469-906-6385
Practice Address - Street 1:12959 JUPITER RD
Practice Address - Street 2:#253
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5223
Practice Address - Country:US
Practice Address - Phone:469-906-6359
Practice Address - Fax:469-906-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2130882Medicaid
TX677807Medicare Oscar/Certification