Provider Demographics
NPI:1245930130
Name:BLOOM BEHAVIOR CENTER,LLC
Entity type:Organization
Organization Name:BLOOM BEHAVIOR CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-305-2401
Mailing Address - Street 1:9950 MARLIN RD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8651
Mailing Address - Country:US
Mailing Address - Phone:305-305-2401
Mailing Address - Fax:
Practice Address - Street 1:513 US HIGHWAY 1 STE 222
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4908
Practice Address - Country:US
Practice Address - Phone:786-663-2985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty