Provider Demographics
NPI:1790593523
Name:BLOSSOM PRIVATE DUTY CARE LLC
Entity type:Organization
Organization Name:BLOSSOM PRIVATE DUTY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-227-3384
Mailing Address - Street 1:2331 FOXY DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-7666
Mailing Address - Country:US
Mailing Address - Phone:678-227-3384
Mailing Address - Fax:678-550-5140
Practice Address - Street 1:2331 FOXY DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-7666
Practice Address - Country:US
Practice Address - Phone:678-227-3384
Practice Address - Fax:678-550-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-26
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health