Blossom Park, LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

BLOSSOM PARK, LLC

Practice address

8535 E Hartford Dr Ste 206
Scottsdale, AZ 85255-5444

Phone

(602) 535-8810

NPI assigned

Nov 7, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nicolette Carter, EDD

Title

Director

Phone

(602) 769-6161

Specialties & licenses 1

Addresses

Other names 1

• Blossom Park Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541548800000",
    "number": "1245708379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8535 E HARTFORD DR STE 206",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852555444",
            "telephone_number": "602-535-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8535 E HARTFORD DR STE 206",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852555444",
            "telephone_number": "602-535-8810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "549 E Plaza Cir Ste D",
            "address_purpose": "LOCATION",
            "city": "Litchfield Park",
            "state": "AZ",
            "postal_code": "853404918",
            "country_code": "US",
            "telephone_number": "602-535-8810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLOSSOM PARK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-07",
        "last_updated": "2018-11-07",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "NICOLETTE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "602-769-6161",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "EDD"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blossom Park",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.