Provider Profile
BLOSSOM BEHAVIOR CENTER LLC
Health Care Clinic
FACILITY PROFILE
Street Address
- 13706 SW 56 ST STE 105-106
MIAMI, FL 33175
County: Miami-Dade - Phone: (786) 688-2630
Mailing Address
- 13706 SW 56 ST STE 105-106
MIAMI, FL 33175
County: Miami-Dade - Phone: (786) 910-7179
AHCA Reports
Inspection ReportsInspection Details
Facility Information:
| Facility/Provider Type: | Health Care Clinic | |||||||||
| Medical or Clinic Director: | RAVISHANKER SUJAMKUMAR | |||||||||
| Administrator: | LISDEYBYS BATLLE | |||||||||
| Owner/Licensee: | BLOSSOM BEHAVIOR CENTER LLC | |||||||||
| Owner/Licensee Since: | 6/29/2020 | |||||||||
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| Profit Status: | For-Profit | |||||||||
| Licensed Beds: | Not Available | |||||||||
| AHCA Number (File Number): | 13237 | |||||||||
| AHCA Field Office: | 11 | |||||||||
| License Number: | 12441 | |||||||||
| Current License Effective: | 9/30/2024 | |||||||||
| Current License Expires: | 9/29/2026 | |||||||||
| License Status: | LICENSED | |||||||||
Services/Characteristics
| Type: | Fixed Location |
Important information and facility/provider definitions can be found in the Glossary.
Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.