MEDICARE: BLOSSOM AID COMMUNITY SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497428221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOM AID COMMUNITY SERVICES LLC

Provider Business Mailing Address
First Line	:	7379 NW 173RD DR APT 103
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-8429
Country	:	US
Telephone Number	:	786-879-0355
Fax Number	:

Provider Business Practice Location Address
First Line	:	7379 NW 173RD DR APT 103
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-8429
Country	:	US
Telephone Number	:	786-879-0355
Fax Number	:	786-953-7451

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SANDRA VELAZQUEZ SILVA
Credential	:	CBHCMS
Telephone Number	:	786-879-0355

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	03/11/2023

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Directions to “BLOSSOM AID COMMUNITY SERVICES LLC ” Practice Location

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