Provider Demographics
NPI:1457545873
Name:SOUTHERN BLOSSOM
Entity Type:Organization
Organization Name:SOUTHERN BLOSSOM
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MS
Authorized Official - First Name:DAHLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-633-2448
Mailing Address - Street 1:378 N LAKE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5421
Mailing Address - Country:US
Mailing Address - Phone:561-633-2448
Mailing Address - Fax:561-682-1947
Practice Address - Street 1:4308 HUNTING TRL
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-3504
Practice Address - Country:US
Practice Address - Phone:561-633-2448
Practice Address - Fax:561-682-1947
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESURRECTION POWER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-29
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility