Provider Demographics
NPI:1437714532
Name:BLOOM BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:BLOOM BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-972-7604
Mailing Address - Street 1:950 N JENNIFER WAY
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-9031
Mailing Address - Country:US
Mailing Address - Phone:562-728-3651
Mailing Address - Fax:
Practice Address - Street 1:209 N N ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4228
Practice Address - Country:US
Practice Address - Phone:559-656-1800
Practice Address - Fax:559-656-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health