MEDICARE: BLOSSOM WELLNESS SUPPORT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	376J00000X	Homemaker
2	251S00000X	Community/Behavioral Health Agency
3	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1285588640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOM WELLNESS SUPPORT

Provider Business Mailing Address
First Line	:	321 AVALON PL
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43611-3736
Country	:	US
Telephone Number	:	567-469-3252
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 AVALON PL
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43611-3736
Country	:	US
Telephone Number	:	567-970-6288
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TANEJA DIXON
Credential	:	RN
Telephone Number	:	567-469-3252

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	03/10/2026

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Directions to “BLOSSOM WELLNESS SUPPORT ” Practice Location

Language	Start Address	Practice Location

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