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General NPI Number Information
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NPI Number | 1497428221
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Entity Type | Organization
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Legal Business Name | BLOSSOM AID COMMUNITY SERVICES LLC
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 03/11/2023
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Provider Practice Location Address
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Address Line | 7379 NW 173RD DR APT 103
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City | HIALEAH
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State | FL
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Zip | 33015-8429
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Country | US
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Telephone | 786-879-0355
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Fax | 786-953-7451
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Provider Business Mailing Address
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Address Line | 7379 NW 173RD DR APT 103
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City | HIALEAH
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State | FL
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Zip | 33015-8429
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Country | US
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Telephone | 786-879-0355
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SANDRA VELAZQUEZ SILVA
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Credential | CBHCMS
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Telephone | 786-879-0355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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