Healthcare Provider Details

I. General information

NPI: 1629930037
Provider Name (Legal Business Name): BLOSSOM FAMILIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 TOPAZ PLZ
DAVIDSON NC
28036-7648
US

IV. Provider business mailing address

2012 TOPAZ PLZ
DAVIDSON NC
28036-7648
US

V. Phone/Fax

Practice location:
  • Phone: 561-716-0804
  • Fax:
Mailing address:
  • Phone: 561-716-0804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JASON ELOWITZ
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 561-716-0804