Blossom Residential LLC

NPI #1518385277 in Prichard, Alabama

Provider Information

NPI Number: 1518385277
Entity Type: Organization
Organization Name: Blossom Residential LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Mar 31, 2014
Last Updated: Mar 31, 2014

Practice Location

Address: 548 MAIN BLVD
City: Prichard
State: Alabama
ZIP Code: 36610-4048
Phone: (251) 643-8885

Authorized Official

Name: MRS. CRYSTAL EIRBY BLACK
Title: CEO
Phone: (251) 643-8885

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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