MEDICARE: BLOSSOM HOME HEALTHCARE, 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	251E00000X	Home Health Agency	HCO-191931	VA

General Provider Information

NPI Number	:	1619450590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOM HOME HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	46191 WESTLAKE DR STE 101
Second Line	:
City	:	POTOMAC FALLS
State	:	VA
Zip	:	20165-5870
Country	:	US
Telephone Number	:	571-313-0209
Fax Number	:	800-491-6153

Provider Business Practice Location Address
First Line	:	46191 WESTLAKE DR STE 101
Second Line	:
City	:	POTOMAC FALLS
State	:	VA
Zip	:	20165-5870
Country	:	US
Telephone Number	:	571-313-0209
Fax Number	:	800-491-6153

Authorized Official
Title or Position	:	COO
Name	:	RODA HASSAN
Credential	:
Telephone Number	:	703-980-2653

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	07/11/2020

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