Provider Demographics
NPI:1891202008
Name:BLOSSOM 24HR HOME CARE LLC
Entity Type:Organization
Organization Name:BLOSSOM 24HR HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLOSSOM
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-696-9249
Mailing Address - Street 1:8102 ALLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4206
Mailing Address - Country:US
Mailing Address - Phone:301-755-6009
Mailing Address - Fax:301-755-6001
Practice Address - Street 1:8102 ALLENDALE DR
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4206
Practice Address - Country:US
Practice Address - Phone:301-755-6009
Practice Address - Fax:301-755-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health