Provider Demographics
NPI:1962667113
Name:BLOSSOM SERVICES, INC.
Entity Type:Organization
Organization Name:BLOSSOM SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BLESSING
Authorized Official - Middle Name:ATOCK
Authorized Official - Last Name:NDANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-432-4856
Mailing Address - Street 1:14116 PARKER FARM WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6325
Mailing Address - Country:US
Mailing Address - Phone:240-432-4856
Mailing Address - Fax:
Practice Address - Street 1:14116 PARKER FARM WAY
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-6325
Practice Address - Country:US
Practice Address - Phone:240-432-4856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-26
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC039527500251S00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency