Provider Demographics
NPI:1417779653
Name:BALANCE & BLOOM HEALTH SERVICES LLC
Entity type:Organization
Organization Name:BALANCE & BLOOM HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JU-LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-250-2930
Mailing Address - Street 1:49611 MOIESE VALLEY RD # B
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-8855
Mailing Address - Country:US
Mailing Address - Phone:406-544-5862
Mailing Address - Fax:
Practice Address - Street 1:49611 MOIESE VALLEY RD # B
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-8855
Practice Address - Country:US
Practice Address - Phone:406-544-5862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0001737859Medicaid