Provider Demographics
NPI:1295496735
Name:BLOOM SERVICES OF MARYLAND
Entity type:Organization
Organization Name:BLOOM SERVICES OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-406-6552
Mailing Address - Street 1:3540 CRAIN HWY # 116
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1303
Mailing Address - Country:US
Mailing Address - Phone:301-379-9245
Mailing Address - Fax:
Practice Address - Street 1:3527 N ROLLING RD STE 7
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2256
Practice Address - Country:US
Practice Address - Phone:443-406-6552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health