Active NPI
Blossom Integrated Health and Behavioral Services LLC
- Psychiatric/Mental Health Nurse Practitioner
- Hagerstown, MD
National Provider Identifier
1043057722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- Legal business name
- BLOSSOM INTEGRATED HEALTH AND BEHAVIORAL SERVICES LLC
- Practice address
- 338 Mill St
Hagerstown, MD 21740-6138 - Phone
- (240) 347-4494
- NPI assigned
- Jul 10, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ihuoma Marvelous Udeagha, DNP
- Title
- Ceo
- Phone
- (240) 347-4494
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | Primary |
Addresses
Primary practice location
338 Mill St
Hagerstown, MD 21740-6138
Mailing address
338 Mill St
Hagerstown, MD 21740-6138
Phone (240) 347-4494
National Provider Directory
National Provider Directory- Tax ID family
- Blossom Integrated Health and Behavioral Services LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Multi-Specialty Clinic/Center
- Hagerstown, MD
- NPI 1003653783
-
- Psychiatry Physician
- Hagerstown, MD
- NPI 1851081095
Locations
338 Mill St
Hagerstown, MD 21740
Phone (240) 347-4494
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Psychiatric/Mental Health Nurse Practitioner
- Hagerstown, MD
- NPI 1649828633
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1720569600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1720569600000",
"number": "1043057722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "338 MILL ST",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "217406138",
"telephone_number": "240-347-4494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "338 MILL ST",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "217406138",
"telephone_number": "240-347-4494"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BLOSSOM INTEGRATED HEALTH AND BEHAVIORAL SERVICES LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-07-10",
"last_updated": "2024-07-10",
"certification_date": "2024-07-10",
"status": "A",
"authorized_official_last_name": "UDEAGHA",
"authorized_official_first_name": "IHUOMA",
"authorized_official_middle_name": "MARVELOUS",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "240-347-4494",
"authorized_official_credential": "DNP"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hagerstown, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.