Provider Demographics
NPI:1134717556
Name:BLOSSOM HEALTHCARE SOLUTIONS, LLC
Entity type:Organization
Organization Name:BLOSSOM HEALTHCARE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GIST
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, CPC
Authorized Official - Phone:317-384-5505
Mailing Address - Street 1:10265 SPARTAN DR STE H
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1237
Mailing Address - Country:US
Mailing Address - Phone:317-384-5505
Mailing Address - Fax:
Practice Address - Street 1:10265 SPARTAN DR STE H
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1237
Practice Address - Country:US
Practice Address - Phone:317-384-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment