Provider Demographics
NPI:1043834757
Name:BLOSSOM CARE AND BEHAVIORAL SERVICES INC
Entity type:Organization
Organization Name:BLOSSOM CARE AND BEHAVIORAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAKEELAT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADEOYE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:202-415-0285
Mailing Address - Street 1:15601 PEACH ORCHARD WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1543
Mailing Address - Country:US
Mailing Address - Phone:202-415-0285
Mailing Address - Fax:
Practice Address - Street 1:15601 PEACH ORCHARD WAY
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1543
Practice Address - Country:US
Practice Address - Phone:202-415-0285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty