Provider Demographics
NPI:1619748639
Name:BLUME MATERNITY SUPPORT SERVICES
Entity Type:Organization
Organization Name:BLUME MATERNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JSHAUNTAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-337-4793
Mailing Address - Street 1:8046 PAVAROTTI AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8264
Mailing Address - Country:US
Mailing Address - Phone:702-337-4793
Mailing Address - Fax:
Practice Address - Street 1:945 W CARSON ST APT 309
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2035
Practice Address - Country:US
Practice Address - Phone:702-337-4793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing