Provider Demographics
NPI:1316699283
Name:LIFE BLOOMS HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:LIFE BLOOMS HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IAISA
Authorized Official - Middle Name:SHIKEMA
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP-BC
Authorized Official - Phone:305-785-7259
Mailing Address - Street 1:3501 NW 212TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1019
Mailing Address - Country:US
Mailing Address - Phone:305-785-7259
Mailing Address - Fax:
Practice Address - Street 1:3501 NW 212TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-1019
Practice Address - Country:US
Practice Address - Phone:305-785-7259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE BLOOMS HEALTHCARE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy