Provider Demographics
NPI:1497428221
Name:BLOSSOM AID COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:BLOSSOM AID COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:CBHCMS
Authorized Official - Phone:786-879-0355
Mailing Address - Street 1:7379 NW 173RD DR APT 103
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-8429
Mailing Address - Country:US
Mailing Address - Phone:786-879-0355
Mailing Address - Fax:
Practice Address - Street 1:7379 NW 173RD DR APT 103
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-8429
Practice Address - Country:US
Practice Address - Phone:786-879-0355
Practice Address - Fax:786-953-7451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109332700Medicaid