Provider Demographics
NPI:1154767606
Name:BLOSSOM HOUSE
Entity type:Organization
Organization Name:BLOSSOM HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FALINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-579-2483
Mailing Address - Street 1:10953 ABBEY ROAD
Mailing Address - Street 2:
Mailing Address - City:N ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133
Mailing Address - Country:US
Mailing Address - Phone:440-652-6749
Mailing Address - Fax:440-652-6949
Practice Address - Street 1:10953 ABBEY
Practice Address - Street 2:
Practice Address - City:N ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133
Practice Address - Country:US
Practice Address - Phone:440-652-6749
Practice Address - Fax:440-652-6949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities