MEDICARE: BLOSSOM CARE SERVICES

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1699905869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOM CARE SERVICES

Provider Business Mailing Address
First Line	:	20702 SHIFTING SAND LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2680
Country	:	US
Telephone Number	:	832-443-9734
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 MISTY FAWN LN
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545-9503
Country	:	US
Telephone Number	:	832-443-9734
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ADAORA EMMANUEL
Credential	:
Telephone Number	:	832-443-9734

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	07/21/2009

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Directions to “BLOSSOM CARE SERVICES ” Practice Location

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