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General NPI Number Information
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NPI Number | 1619450590
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Entity Type | Organization
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Legal Business Name | BLOSSOM HOME HEALTHCARE, LLC
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 07/11/2020
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Provider Practice Location Address
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Address Line | 46191 WESTLAKE DR STE 101
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City | POTOMAC FALLS
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State | VA
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Zip | 20165-5870
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Country | US
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Telephone | 571-313-0209
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Fax | 800-491-6153
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Provider Business Mailing Address
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Address Line | 46191 WESTLAKE DR STE 101
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City | POTOMAC FALLS
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State | VA
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Zip | 20165-5870
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Country | US
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Telephone | 571-313-0209
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Fax | 800-491-6153
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Authorized Official
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Title or Position | COO
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Name | RODA HASSAN
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Credential |
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Telephone | 703-980-2653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCO-191931
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License Number State | VA
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