Provider Demographics
NPI:1780088609
Name:BLOOM BEHAVIORAL SOLUTIONS
Entity type:Organization
Organization Name:BLOOM BEHAVIORAL SOLUTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKEY COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-647-1849
Mailing Address - Street 1:997 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-3311
Mailing Address - Country:US
Mailing Address - Phone:904-647-1849
Mailing Address - Fax:904-647-2625
Practice Address - Street 1:997 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:FL
Practice Address - Zip Code:32233-3311
Practice Address - Country:US
Practice Address - Phone:904-647-1849
Practice Address - Fax:904-647-2625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLOOM BEHAVIORAL SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-21
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty