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General NPI Number Information
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NPI Number | 1457545873
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Entity Type | Organization
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Legal Business Name | SOUTHERN BLOSSOM
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 4308 HUNTING TRL
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City | LAKE WORTH
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State | FL
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Zip | 33467-3504
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Country | US
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Telephone | 561-633-2448
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Fax | 561-682-1947
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Provider Business Mailing Address
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Address Line | 378 N LAKE BLVD SUITE 120
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City | NORTH PALM BEACH
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State | FL
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Zip | 33408-5421
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Country | US
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Telephone | 561-633-2448
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Fax | 561-682-1947
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Authorized Official
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Title or Position | C.E.O.
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Name | MS. DAHLIA JONES
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Credential |
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Telephone | 561-633-2448
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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 | FL
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