Organization
BLOSSOM SUPPORT COORDINATION LLC
Active
Other names
Blossom Support Coordination
Organization subpart
No
Provider details
NPI number
Authorized official
TORI GUILLORY (EXECUTIVE DIRECTOR)
(225) 409-7390
Entity
Organization
Contact information
Practice address
9800 AIRLINE HWY STE 253, BATON ROUGE, LA 70816-8006
(225) 409-7390
(225) 250-1514
Mailing address
9800 AIRLINE HWY STE 107, BATON ROUGE, LA 70816-8000
(225) 409-7390
(225) 250-1514
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2570781
—
LA
05
—
2651315
—
LA
Enumeration date
03/21/2022
Last updated
06/03/2024
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