Provider Demographics
NPI:1639907090
Name:BLOOMWELL HEALTH LLC
Entity type:Organization
Organization Name:BLOOMWELL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHINONYE
Authorized Official - Middle Name:
Authorized Official - Last Name:EGBULEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-688-5987
Mailing Address - Street 1:128 S TRYON ST FL 18
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-5001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:128 S TRYON ST FL 18
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-5001
Practice Address - Country:US
Practice Address - Phone:202-688-5987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health