Provider Demographics
NPI:1336035203
Name:BLOOMING GEM LLC
Entity type:Organization
Organization Name:BLOOMING GEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PLMHP
Authorized Official - Phone:402-807-3356
Mailing Address - Street 1:4376 LAUREL AVE
Mailing Address - Street 2:N/A
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111
Mailing Address - Country:US
Mailing Address - Phone:402-807-3356
Mailing Address - Fax:
Practice Address - Street 1:4376 LAUREL AVE
Practice Address - Street 2:N/A
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111
Practice Address - Country:US
Practice Address - Phone:402-807-3356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty