Healthcare Provider Details

I. General information

NPI: 1548182595
Provider Name (Legal Business Name): BLOSSOM IN HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15054 BRODIE LN
WINTER GARDEN FL
34787-7220
US

IV. Provider business mailing address

15054 BRODIE LN
WINTER GARDEN FL
34787-7220
US

V. Phone/Fax

Practice location:
  • Phone: 929-272-6871
  • Fax:
Mailing address:
  • Phone: 929-272-6871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: CHARMAINE C MILLER
Title or Position: PROVIDER
Credential: HOME CARE PROVIDER
Phone: 929-272-6871