Healthcare Provider Details

I. General information

NPI: 1790593523
Provider Name (Legal Business Name): BLOSSOM PRIVATE DUTY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 WATERFRONT PL
SNELLVILLE GA
30039-8594
US

IV. Provider business mailing address

3435 WATERFRONT PL
SNELLVILLE GA
30039-8594
US

V. Phone/Fax

Practice location:
  • Phone: 678-227-3384
  • Fax: 678-550-5140
Mailing address:
  • Phone: 678-227-3384
  • Fax: 678-550-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER OLIVIA BAILEY
Title or Position: OWNER
Credential:
Phone: 678-227-3384