Provider Demographics
NPI:1962183574
Name:BLOSSOM LIVING LLC
Entity type:Organization
Organization Name:BLOSSOM LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LADYWINNIE
Authorized Official - Middle Name:AMOO
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-578-8416
Mailing Address - Street 1:2261 S QUAIL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-7982
Mailing Address - Country:US
Mailing Address - Phone:619-578-8416
Mailing Address - Fax:520-844-6840
Practice Address - Street 1:5441 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-5441
Practice Address - Country:US
Practice Address - Phone:619-578-8416
Practice Address - Fax:520-844-6840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty