Blossom Manor LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BLOSSOM MANOR LLC

Practice address

2607 Killdeer LN
Humble, TX 77396-1827

Phone

(281) 570-6257

Fax

(832) 678-5119

NPI assigned

Nov 29, 2023

Organization subpart

No

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

Authorized official

Name

Crashonda Rena Dewalt

Title

Program Manager

Phone

(832) 579-4545

Specialties & licenses 2

Addresses

Tax ID family

Blossom Manor LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Blossom Manor LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Humble, TX
  • NPI 1750119939
  NPD tax ID

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

{
    "created_epoch": "1701216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781222400000",
    "number": "1548036759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3207 HAYDEN SPRINGS CT",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773963097",
            "telephone_number": "832-579-4545",
            "fax_number": "832-678-5119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2607 KILLDEER LN",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773961827",
            "telephone_number": "281-570-6257",
            "fax_number": "832-678-5119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-29",
        "last_updated": "2026-06-12",
        "certification_date": "2026-06-12",
        "status": "A",
        "authorized_official_last_name": "DEWALT",
        "authorized_official_first_name": "CRASHONDA",
        "authorized_official_middle_name": "RENA",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "832-579-4545"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ofonime Awakessien Bleess, APRN
• Kelly Ann Blessing, ATP
• Cynthia A Blizzard, MD
• Bloom Community Services
• Bloom Consulting, LLC (Bloom Consulting)
• Blossom Manor LLC
• Latonya Danielle Blount, BS, MS-CMHC
• Blueventra LLC
• Blueventra LLC
• Kimbria Nicole Blunt, FNP-BC

• Assisted Living Facility in Humble, TX
• Providers in Humble, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2026; 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.