MEDICARE: CHERRY BLOSSOM HOME CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	291U00000X	Clinical Medical Laboratory
2	251J00000X	Nursing Care Agency
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1821640681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHERRY BLOSSOM HOME CARE LLC

Provider Business Mailing Address
First Line	:	13003 PAYTON DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1907
Country	:	US
Telephone Number	:	240-651-9009
Fax Number	:	301-249-1651

Provider Business Practice Location Address
First Line	:	13003 PAYTON DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1907
Country	:	US
Telephone Number	:	240-651-9009
Fax Number	:	301-249-1651

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MS. LASHANNA JILLIAN COX
Credential	:
Telephone Number	:	240-651-9009

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	02/24/2022

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