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General NPI Number Information
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NPI Number | 1912602509
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Entity Type | Organization
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Legal Business Name | BLOSSOM CARE COORDINATION LLC
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 48375 W. POPPY LANE UNIT B
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City | SOLDOTNA
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State | AK
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Zip | 99669
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Country | US
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Telephone | 907-598-1660
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Fax | 907-885-0020
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Provider Business Mailing Address
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Address Line | PO BOX 603
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City | SOLDOTNA
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State | AK
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Zip | 99669
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Country | US
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Telephone | 907-598-1660
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Fax | 907-885-0020
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Authorized Official
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Title or Position | OWNER
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Name | SHADY LEE COOK
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Credential |
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Telephone | 907-598-1660
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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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