Healthcare Provider Details

I. General information

NPI: 1821640681
Provider Name (Legal Business Name): CHERRY BLOSSOM HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13003 PAYTON DR
UPPER MARLBORO MD
20774-1907
US

IV. Provider business mailing address

13003 PAYTON DR
UPPER MARLBORO MD
20774-1907
US

V. Phone/Fax

Practice location:
  • Phone: 240-651-9009
  • Fax: 301-249-1651
Mailing address:
  • Phone: 240-651-9009
  • Fax: 301-249-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. LASHANNA JILLIAN COX
Title or Position: OWNER/CEO
Credential:
Phone: 240-651-9009