Blossom Manor LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

BLOSSOM MANOR LLC

Practice address

3207 Hayden Springs CT
Humble, TX 77396-3097

Phone

(832) 579-4545

NPI assigned

Jul 22, 2024

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, RN

Title

Program Manager

Phone

(832) 579-4545

Specialties & licenses 1

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

  • Assisted Living Facility
  • Humble, TX
  • NPI 1548036759
  NPD tax ID

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

{
    "created_epoch": "1721606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784851200000",
    "number": "1750119939",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3207 HAYDEN SPRINGS CT",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773963097",
            "telephone_number": "832-579-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-22",
        "last_updated": "2026-07-24",
        "certification_date": "2026-07-24",
        "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",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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
• BNN Anesthesia PLLC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Humble, TX
• Providers in Humble, TX by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.