Provider Demographics
NPI:1124271267
Name:CHERRY BLOSSOM CARE AGENCY, INC
Entity type:Organization
Organization Name:CHERRY BLOSSOM CARE AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:DENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-336-7545
Mailing Address - Street 1:4006 CARTER STREET
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-3013
Mailing Address - Country:US
Mailing Address - Phone:318-336-7545
Mailing Address - Fax:318-336-7544
Practice Address - Street 1:4006 CARTER STREET
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3013
Practice Address - Country:US
Practice Address - Phone:318-336-7545
Practice Address - Fax:318-336-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care