Provider Demographics
NPI:1790419596
Name:BLOOMING THERAPEUTIC GARDEN LLC
Entity Type:Organization
Organization Name:BLOOMING THERAPEUTIC GARDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/QUALITY ASSURANCE PERSONNEL
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP, TSSLD/BE
Authorized Official - Phone:212-795-7571
Mailing Address - Street 1:809 W 177TH ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6600
Mailing Address - Country:US
Mailing Address - Phone:212-795-7571
Mailing Address - Fax:212-795-7571
Practice Address - Street 1:809 W 177TH ST APT 3A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6600
Practice Address - Country:US
Practice Address - Phone:212-795-7571
Practice Address - Fax:212-795-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency