Blossoms Assisted Living 1, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

10287 Issued in FL

Legal business name

BLOSSOMS ASSISTED LIVING 1, LLC

Practice address

1799 Sereno Dr
Davenport, FL 33896-8603

Phone

(863) 420-1463

NPI assigned

Apr 16, 2015

Last updated

Apr 16, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

BLOSSOMS SUPPORT SERVICES LLCAs reported in NPPES

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

Authorized official

Name

Mr. Paul Sturdgess Hayes

Title

Administrator

Phone

(386) 257-2162

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Justina Threadgill

  • Assisted Living Facility
  • Daytona Beach, FL
  • NPI 1942624366
  NPD (past)

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

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429142400000",
    "number": "1588051528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 MARDRAKE RD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321145940",
            "telephone_number": "386-257-2162",
            "fax_number": "386-257-2162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1799 SERENO DR",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338968603",
            "telephone_number": "863-420-1463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOMS ASSISTED LIVING 1, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLOSSOMS SUPPORT SERVICES LLC",
        "enumeration_date": "2015-04-16",
        "last_updated": "2015-04-16",
        "status": "A",
        "authorized_official_last_name": "STURDGESS HAYES",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "386-257-2162",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "10287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Felix U Bigay-Rodriguez, M.D.
• Renee Bischoff
• Mary L Bixler
• BJ's Wholesale Club Inc.
• Tatjana Blazin, MD
• Alise Blount
• Bogle Medical Care and Aesthetics
• Jacqueline Bogle, APRN
• Alayne N Boland, ARNP-C
• Delainne Ivy Bond, RN

• Assisted Living Facility in Davenport, FL
• Providers in Davenport, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; 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.