Provider Demographics
NPI:1083585608
Name:BLOSSOM HEALTHCARE LLC
Entity type:Organization
Organization Name:BLOSSOM HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:SIMCHA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:KROHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-664-4836
Mailing Address - Street 1:26 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4701
Mailing Address - Country:US
Mailing Address - Phone:516-295-3294
Mailing Address - Fax:
Practice Address - Street 1:3051 WHITESIDE RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-6209
Practice Address - Country:US
Practice Address - Phone:478-347-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility