1457497232 NPI number — BLOSSOM GROUPS CORPORATION

Table of content: (NPI 1457497232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457497232 NPI number — BLOSSOM GROUPS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLOSSOM GROUPS CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BLOSSOM HOME HEALTHCARE SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457497232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12959 JUPITER RD
Provider Second Line Business Mailing Address:
#253
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75238-5223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-906-6359
Provider Business Mailing Address Fax Number:
469-906-6385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12959 JUPITER RD
Provider Second Line Business Practice Location Address:
#253
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75238-5223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-906-6359
Provider Business Practice Location Address Fax Number:
469-906-6385
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AKOGU
Authorized Official First Name:
UKACHI
Authorized Official Middle Name:
Authorized Official Title or Position:
RN
Authorized Official Telephone Number:
469-906-6359

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2130882 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com