MEDICARE: BLOSSOM SUPPORT COORDINATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598414393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOM SUPPORT COORDINATION LLC

Provider Business Mailing Address
First Line	:	9800 AIRLINE HWY STE 107
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-8000
Country	:	US
Telephone Number	:	225-409-7390
Fax Number	:	225-250-1514

Provider Business Practice Location Address
First Line	:	9800 AIRLINE HWY STE 253
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-8006
Country	:	US
Telephone Number	:	225-409-7390
Fax Number	:	225-250-1514

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TORI GUILLORY
Credential	:
Telephone Number	:	225-409-7390

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	06/03/2024

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Directions to “BLOSSOM SUPPORT COORDINATION LLC ” Practice Location

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