Provider Demographics
NPI:1780129379
Name:CHERRY BLOSSOM HOME HEALTH, INC.
Entity type:Organization
Organization Name:CHERRY BLOSSOM HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA ROSELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-999-8515
Mailing Address - Street 1:577 N D ST
Mailing Address - Street 2:STE 105
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1324
Mailing Address - Country:US
Mailing Address - Phone:909-999-8515
Mailing Address - Fax:888-754-7048
Practice Address - Street 1:577 N D ST
Practice Address - Street 2:STE 105
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1324
Practice Address - Country:US
Practice Address - Phone:909-999-8515
Practice Address - Fax:888-754-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health