Provider Demographics
NPI:1780559104
Name:EMBER & BLOOM HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:EMBER & BLOOM HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRIM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:724-963-0580
Mailing Address - Street 1:655 CHERRY TREE LN
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8947
Mailing Address - Country:US
Mailing Address - Phone:724-415-9169
Mailing Address - Fax:
Practice Address - Street 1:655 CHERRY TREE LN
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8947
Practice Address - Country:US
Practice Address - Phone:724-415-9169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)