Provider Demographics
NPI:1982454518
Name:ELDER BLOOM CARE LLC
Entity Type:Organization
Organization Name:ELDER BLOOM CARE LLC
Other - Org Name:22-JUNE-2023
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-401-4799
Mailing Address - Street 1:1143 OLD VINTAGE RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8875
Mailing Address - Country:US
Mailing Address - Phone:757-401-4799
Mailing Address - Fax:332-253-5293
Practice Address - Street 1:1143 OLD VINTAGE RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8875
Practice Address - Country:US
Practice Address - Phone:757-401-4799
Practice Address - Fax:332-253-5293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty