Provider Demographics
NPI:1679196034
Name:BLOSSOM CARE INC.
Entity Type:Organization
Organization Name:BLOSSOM CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/DPCS
Authorized Official - Prefix:
Authorized Official - First Name:HAYKANUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHISHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-430-5895
Mailing Address - Street 1:1500 W SHAW AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3501
Mailing Address - Country:US
Mailing Address - Phone:559-430-5895
Mailing Address - Fax:
Practice Address - Street 1:1500 W SHAW AVE STE 302
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3501
Practice Address - Country:US
Practice Address - Phone:559-430-5895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health