Provider Demographics
NPI:1790534105
Name:BLOSSOM EVER-CARE HOME INC
Entity type:Organization
Organization Name:BLOSSOM EVER-CARE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SOLANGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATCHOUABOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-487-4007
Mailing Address - Street 1:4224 STONEWALL DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3010
Mailing Address - Country:US
Mailing Address - Phone:214-487-4007
Mailing Address - Fax:
Practice Address - Street 1:4224 STONEWALL DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-3010
Practice Address - Country:US
Practice Address - Phone:214-487-4007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No251E00000XAgenciesHome Health