Provider Demographics
NPI:1811585219
Name:AG BLOSSOM LLC
Entity Type:Organization
Organization Name:AG BLOSSOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANAB
Authorized Official - Middle Name:
Authorized Official - Last Name:GURHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-220-3917
Mailing Address - Street 1:1719 CROSSINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-8519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1719 CROSSINGS BLVD
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-8519
Practice Address - Country:US
Practice Address - Phone:952-220-3917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AG BLOSSOM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care