Provider Demographics
NPI:1649080672
Name:BLOOM CARE GROUP LLC
Entity type:Organization
Organization Name:BLOOM CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TENYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-707-7284
Mailing Address - Street 1:11300 IRON BRIDGE RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1428
Mailing Address - Country:US
Mailing Address - Phone:804-707-7284
Mailing Address - Fax:804-710-2024
Practice Address - Street 1:11300 IRON BRIDGE RD STE B
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1428
Practice Address - Country:US
Practice Address - Phone:804-707-7284
Practice Address - Fax:804-710-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health