Provider Demographics
NPI:1417284258
Name:BLOOMHEALTH HOME CARE SERVICES, LLC.
Entity Type:Organization
Organization Name:BLOOMHEALTH HOME CARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OBIAGELI
Authorized Official - Middle Name:CHRISTIANA
Authorized Official - Last Name:EZEANYA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-729-3970
Mailing Address - Street 1:16250 NORTHLAND DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5205
Mailing Address - Country:US
Mailing Address - Phone:313-729-3970
Mailing Address - Fax:
Practice Address - Street 1:16250 NORTHLAND DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5205
Practice Address - Country:US
Practice Address - Phone:313-729-3970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health