Individual
BLOSSOM MARSHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8520 NW 46TH CT, LAUDERHILL, FL 33351-5425
(954) 572-3135
Mailing address
3338 NW 22ND ST, LAUDERDALE LAKES, FL 33311-2714
(954) 309-6858
(754) 551-6178
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010610800
—
FL
Enumeration date
01/21/2022
Last updated
01/21/2022
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