Provider Demographics
NPI:1598336091
Name:BLOSSOM HEALTH AND WELLNESS /CENTER, LLC
Entity Type:Organization
Organization Name:BLOSSOM HEALTH AND WELLNESS /CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-974-3571
Mailing Address - Street 1:7205 ALMEDA RD # 300837
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2191
Mailing Address - Country:US
Mailing Address - Phone:281-974-3571
Mailing Address - Fax:346-867-3110
Practice Address - Street 1:8389 ALMEDA RD STE H1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-7105
Practice Address - Country:US
Practice Address - Phone:601-813-9102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4315442-01Medicaid