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General NPI Number Information
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NPI Number | 1609048602
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Entity Type | Organization
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Legal Business Name | BURKEBLOSSOM MONICA
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 907 N TAYLOR RD
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City | BRANDON
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State | FL
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Zip | 33510-3121
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Country | US
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Telephone | 813-684-3702
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Fax | 813-684-3702
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Provider Business Mailing Address
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Address Line | 907 N TAYLOR RD
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City | BRANDON
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State | FL
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Zip | 33510-3121
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Country | US
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Telephone | 813-684-3702
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Fax | 813-684-3702
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Authorized Official
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Title or Position | OWNER/CAREGIVER
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Name | BLOSSOM MONICA BURKE
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Credential | N/A
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Telephone | 813-684-3702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6906191
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License Number State | FL
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