Provider Demographics
NPI:1770443806
Name:BREAK FORTH AND BLOSSOM
Entity type:Organization
Organization Name:BREAK FORTH AND BLOSSOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MRG
Authorized Official - Prefix:
Authorized Official - First Name:NILA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERNARDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:645-243-9222
Mailing Address - Street 1:357 NW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-3739
Mailing Address - Country:US
Mailing Address - Phone:645-243-9222
Mailing Address - Fax:
Practice Address - Street 1:357 NW 31ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3739
Practice Address - Country:US
Practice Address - Phone:645-243-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BREAK FORTH AND BLOSSOM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care