Provider Demographics
NPI:1144884966
Name:ROOM TO BLOOM, LLC
Entity type:Organization
Organization Name:ROOM TO BLOOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:BROOK
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-490-7299
Mailing Address - Street 1:101 HIDDEN SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-5647
Mailing Address - Country:US
Mailing Address - Phone:864-490-7299
Mailing Address - Fax:864-761-1014
Practice Address - Street 1:101 HIDDEN SPRINGS CT
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-5647
Practice Address - Country:US
Practice Address - Phone:864-490-7299
Practice Address - Fax:864-761-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency