Provider Demographics
NPI:1528842754
Name:BLOSSOM HOME CARE, LLC
Entity type:Organization
Organization Name:BLOSSOM HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:LUWIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-851-9598
Mailing Address - Street 1:1613 BUNTING FOREST CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2949
Mailing Address - Country:US
Mailing Address - Phone:678-851-9598
Mailing Address - Fax:678-992-5556
Practice Address - Street 1:1613 BUNTING FOREST CT
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2949
Practice Address - Country:US
Practice Address - Phone:678-851-9598
Practice Address - Fax:678-992-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care