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General NPI Number Information
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NPI Number | 1730717471
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Entity Type | Organization
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Legal Business Name | BLOSSOM HERE
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 101-105 N YORK STREET
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City | LANCASTER
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State | SC
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Zip | 29720-2972
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Country | US
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Telephone | 803-999-3798
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Fax | 803-636-8201
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Provider Business Mailing Address
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Address Line | 9169 DRAYTON LN
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City | FORT MILL
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State | SC
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Zip | 29707-5848
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Country | US
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Telephone | 201-852-2309
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Fax | 201-852-2309
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Authorized Official
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Title or Position | PRESIDENT
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Name | QUIANA MESHELL DIXON
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Credential |
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Telephone | 803-999-3798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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