Organization
BLOSSOM MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRASHONDA RENA DEWALT (PROGRAM MANAGER)
(832) 579-4545
Entity
Organization
Contact information
Practice address
2607 KILLDEER LN, HUMBLE, TX 77396-1827
(281) 570-6257
(832) 678-5119
Mailing address
3207 HAYDEN SPRINGS CT, HUMBLE, TX 77396-3097
(832) 579-4545
(832) 678-5119
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
11/29/2023
Last updated
06/12/2026
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