Provider Demographics
NPI:1215691472
Name:BLOOM HOSPICE LLC
Entity type:Organization
Organization Name:BLOOM HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALEED
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-644-2066
Mailing Address - Street 1:5901 CHASE RD STE 210A
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-0900
Mailing Address - Country:US
Mailing Address - Phone:313-644-2066
Mailing Address - Fax:313-650-3030
Practice Address - Street 1:5901 CHASE RD STE 210A
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-0900
Practice Address - Country:US
Practice Address - Phone:313-644-2066
Practice Address - Fax:313-650-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based