Provider Demographics
NPI:1619450590
Name:BLOSSOM HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:BLOSSOM HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RODA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-980-2653
Mailing Address - Street 1:46191 WESTLAKE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5870
Mailing Address - Country:US
Mailing Address - Phone:571-313-0209
Mailing Address - Fax:800-491-6153
Practice Address - Street 1:46191 WESTLAKE DR STE 101
Practice Address - Street 2:
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5870
Practice Address - Country:US
Practice Address - Phone:571-313-0209
Practice Address - Fax:800-491-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-191931251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health