Healthcare Provider Details

I. General information

NPI: 1447197405
Provider Name (Legal Business Name): BLOSSOM CARE FOR THE ELDERLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 W AVENUE H1
LANCASTER CA
93534-5443
US

IV. Provider business mailing address

1803 W AVENUE H1
LANCASTER CA
93534-5443
US

V. Phone/Fax

Practice location:
  • Phone: 661-341-7594
  • Fax:
Mailing address:
  • Phone: 661-341-7594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CHERRY MAY JACINTO
Title or Position: LICENSEE
Credential:
Phone: 661-341-7594