Provider Demographics
NPI:1538648449
Name:BLOSSOM HOSPICE, INC.
Entity type:Organization
Organization Name:BLOSSOM HOSPICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHUSHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:YESAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-230-2288
Mailing Address - Street 1:13615 VICTORY BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1795
Mailing Address - Country:US
Mailing Address - Phone:818-290-3050
Mailing Address - Fax:818-301-3179
Practice Address - Street 1:13615 VICTORY BLVD STE 213
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1795
Practice Address - Country:US
Practice Address - Phone:818-290-3050
Practice Address - Fax:818-301-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health