Provider Demographics
NPI:1699578112
Name:BLOSSOM IN UNITY, LLC
Entity type:Organization
Organization Name:BLOSSOM IN UNITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCRECIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-410-4475
Mailing Address - Street 1:6835 NE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4020
Mailing Address - Country:US
Mailing Address - Phone:503-410-4475
Mailing Address - Fax:877-744-1853
Practice Address - Street 1:1012 SW KING AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1106
Practice Address - Country:US
Practice Address - Phone:503-410-4475
Practice Address - Fax:877-744-1853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty