Organization
BLOSSOM RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRYSTAL EIRBY BLACK (CEO)
(251) 643-8885
Entity
Organization
Contact information
Practice address
548 MAIN BLVD, PRICHARD, AL 36610-4048
(251) 643-8885
Mailing address
PO BOX 774, MOBILE, AL 36601-0774
(251) 643-8885
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/31/2014
Last updated
03/31/2014
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