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General NPI Number Information
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NPI Number | 1073125886
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Entity Type | Organization
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Legal Business Name | BLOSSOM & EVOLVE, LLC
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 78 BUENA VISTA DR
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City | NEW CASTLE
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State | DE
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Zip | 19720-4660
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Country | US
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Telephone | 302-525-1499
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26502
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City | WILMINGTON
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State | DE
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Zip | 19899-6502
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Country | US
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Telephone | 302-433-9014
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. NYCHOLE SHA-REESE WRIGHT
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Credential |
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Telephone | 302-433-9014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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