Provider Demographics
NPI:1346580776
Name:BLOOM ALASKA HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:BLOOM ALASKA HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CECILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-317-6822
Mailing Address - Street 1:341 W TUDOR RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6639
Mailing Address - Country:US
Mailing Address - Phone:907-770-8588
Mailing Address - Fax:907-868-8873
Practice Address - Street 1:341 W TUDOR RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6639
Practice Address - Country:US
Practice Address - Phone:907-770-8588
Practice Address - Fax:907-868-8873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based