Provider Demographics
NPI:1104396118
Name:BLOOM PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:BLOOM PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAJOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-652-5911
Mailing Address - Street 1:14650 W WARREN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1782
Mailing Address - Country:US
Mailing Address - Phone:313-652-5911
Mailing Address - Fax:
Practice Address - Street 1:14650 W WARREN AVE STE 300
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1782
Practice Address - Country:US
Practice Address - Phone:313-652-5911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty