Provider Demographics
NPI:1508432659
Name:BLOOM HOSPICE LLC
Entity Type:Organization
Organization Name:BLOOM HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALEED
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:346-409-6361
Mailing Address - Street 1:8125 N SAM HOUSTON PKWY W STE B-2
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-3450
Mailing Address - Country:US
Mailing Address - Phone:346-409-6361
Mailing Address - Fax:346-214-7100
Practice Address - Street 1:8125 N SAM HOUSTON PKWY W STE B-2
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-3450
Practice Address - Country:US
Practice Address - Phone:346-409-6361
Practice Address - Fax:346-214-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-30
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based