Provider Demographics
NPI:1174153449
Name:BLOSSOM BEHAVIOR CENTER LLC
Entity type:Organization
Organization Name:BLOSSOM BEHAVIOR CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISDEYBYS
Authorized Official - Middle Name:
Authorized Official - Last Name:BATLLE LORENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-523-4289
Mailing Address - Street 1:13706 SW 56TH ST STE 105-106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6036
Mailing Address - Country:US
Mailing Address - Phone:786-688-2630
Mailing Address - Fax:786-513-8495
Practice Address - Street 1:13706 SW 56TH ST STE 105-106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6036
Practice Address - Country:US
Practice Address - Phone:786-688-2630
Practice Address - Fax:786-513-8495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health