Provider Demographics
NPI:1154187193
Name:BLOOM HEALTH LLC
Entity type:Organization
Organization Name:BLOOM HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:LEVITICUS
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:443-457-0699
Mailing Address - Street 1:3375 ELLICOTT CENTER DR
Mailing Address - Street 2:#697
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21041
Mailing Address - Country:US
Mailing Address - Phone:443-457-0699
Mailing Address - Fax:917-268-9786
Practice Address - Street 1:3184 RIVER VALLEY CHASE
Practice Address - Street 2:
Practice Address - City:WEST FRIENDSHIP
Practice Address - State:MD
Practice Address - Zip Code:21794-9542
Practice Address - Country:US
Practice Address - Phone:443-457-0699
Practice Address - Fax:917-268-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty