Provider Demographics
NPI:1477247716
Name:ECOBLOSSOM INC
Entity Type:Organization
Organization Name:ECOBLOSSOM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINA
Authorized Official - Middle Name:NWAKAEGO
Authorized Official - Last Name:OGBUJI
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:667-217-7962
Mailing Address - Street 1:3815 FERNHILL AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5618
Mailing Address - Country:US
Mailing Address - Phone:667-217-9262
Mailing Address - Fax:
Practice Address - Street 1:3815 FERNHILL AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5618
Practice Address - Country:US
Practice Address - Phone:667-127-9262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty