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General NPI Number Information
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NPI Number | 1275862963
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Entity Type | Organization
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Legal Business Name | BLOSSOM HEALTH SERVICES
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 2416 NEWBERRY LN
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City | MOUNT JULIET
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State | TN
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Zip | 37122-7460
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Country | US
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Telephone | 615-553-4325
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Fax | 615-754-6724
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Provider Business Mailing Address
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Address Line | 2416 NEWBERRY LN
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City | MOUNT JULIET
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State | TN
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Zip | 37122-7460
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Country | US
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Telephone | 615-553-4325
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Fax | 615-754-6724
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. GERTRUDE A KISOB
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Credential |
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Telephone | 615-553-4325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | PSS0000000257
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License Number State | TN
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