Provider Demographics
NPI:1457009789
Name:BLOOMKIDZ INC.
Entity Type:Organization
Organization Name:BLOOMKIDZ INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FEAVEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-853-6052
Mailing Address - Street 1:2141 E PECOS RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6077
Mailing Address - Country:US
Mailing Address - Phone:480-846-0607
Mailing Address - Fax:480-841-6696
Practice Address - Street 1:2141 E PECOS RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-6077
Practice Address - Country:US
Practice Address - Phone:480-846-0607
Practice Address - Fax:480-841-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC13281OtherARIZONA DEPARTMENTS OF HEALTH SERVICES
AZ155000Medicaid
AZBH9666OtherARIZONA DEPARTMENT OF HEALTH SERVICES