Healthcare Provider Details

I. General information

NPI: 1962667113
Provider Name (Legal Business Name): BLOSSOM SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2008
Last Update Date: 07/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14116 PARKER FARM WAY
SILVER SPRING MD
20906-6325
US

IV. Provider business mailing address

14116 PARKER FARM WAY
SILVER SPRING MD
20906-6325
US

V. Phone/Fax

Practice location:
  • Phone: 240-432-4856
  • Fax:
Mailing address:
  • Phone: 240-432-4856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number039527500
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number039527500
License Number StateDC

VIII. Authorized Official

Name: BLESSING ATOCK NDANG
Title or Position: CEO
Credential:
Phone: 240-432-4856