Healthcare Provider Details

I. General information

NPI: 1245937242
Provider Name (Legal Business Name): BLOSSOM BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FRANKLIN SQUARE DR STE 4
SOMERSET NJ
08873-4109
US

IV. Provider business mailing address

100 FRANKLIN SQUARE DR STE 4
SOMERSET NJ
08873-4109
US

V. Phone/Fax

Practice location:
  • Phone: 908-280-2518
  • Fax:
Mailing address:
  • Phone: 908-280-2518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: NENEH BINTA BARRIE
Title or Position: DIRECTOR
Credential:
Phone: 908-280-2518