Provider Demographics
NPI:1639630858
Name:BLOOM AND SHINE SERVICES LLC
Entity Type:Organization
Organization Name:BLOOM AND SHINE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDATHOKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-262-0500
Mailing Address - Street 1:90 AIRPORT RD STE 27
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90 AIRPORT RD STE 27
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5326
Practice Address - Country:US
Practice Address - Phone:603-262-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care