Provider Demographics
NPI:1023693801
Name:BLOSSOM SERVICES GROUP LLC
Entity type:Organization
Organization Name:BLOSSOM SERVICES GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAHR
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:717-418-3699
Mailing Address - Street 1:2046 RUTTAN CT
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-4258
Mailing Address - Country:US
Mailing Address - Phone:717-418-3699
Mailing Address - Fax:
Practice Address - Street 1:2046 RUTTAN CT
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-4258
Practice Address - Country:US
Practice Address - Phone:717-418-3699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty