Blossom Health Services

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

PSS0000000257 Issued in TN

Legal business name

BLOSSOM HEALTH SERVICES

Practice address

2416 Newberry LN
Mount Juliet, TN 37122-7460

Phone

(615) 553-4325

Fax

(615) 754-6724

NPI assigned

Dec 9, 2009

Last updated

Dec 9, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Gertrude A Kisob

Title

Executive Director

Phone

(615) 553-4325

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1260316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260316800000",
    "number": "1275862963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2416 NEWBERRY LN",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371227460",
            "telephone_number": "615-553-4325",
            "fax_number": "615-754-6724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2416 NEWBERRY LN",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371227460",
            "telephone_number": "615-553-4325",
            "fax_number": "615-754-6724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-09",
        "last_updated": "2009-12-09",
        "status": "A",
        "authorized_official_last_name": "KISOB",
        "authorized_official_first_name": "GERTRUDE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "615-553-4325",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "TN",
            "license": "PSS0000000257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H445294",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2009; 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.