Provider Demographics
NPI:1770287823
Name:BLUE BLOSSOM CARE ABA THERAPY LLLP
Entity type:Organization
Organization Name:BLUE BLOSSOM CARE ABA THERAPY LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-561-0340
Mailing Address - Street 1:1431 SILVERGATE WAY
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-6101
Mailing Address - Country:US
Mailing Address - Phone:470-561-0340
Mailing Address - Fax:
Practice Address - Street 1:1431 SILVERGATE WAY
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-6101
Practice Address - Country:US
Practice Address - Phone:470-561-0340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty