Blossom Manor LLC

NPI #1750119939 in Humble, Texas

Provider Information

NPI Number: 1750119939
Entity Type: Organization
Organization Name: Blossom Manor LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Jul 22, 2024
Last Updated: Aug 11, 2024

Practice Location

Address: 3207 HAYDEN SPRINGS CT
City: Humble
State: Texas
ZIP Code: 77396-3097
Phone: (832) 579-4545

Authorized Official

Name: CRASHONDA R DEWALT, RN
Title: STAFF END USER/ PROGRAM PROVIDER
Phone: (832) 579-4545

Specialties & Taxonomy Codes

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

Additional Practice Locations

2607 Killdeer Ln

Humble, TX, 77396-1827

(281) 570-6257

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