Provider Demographics
NPI:1699528422
Name:BLOOMING OAKS WELLNESS & REHABILITATION LLC
Entity type:Organization
Organization Name:BLOOMING OAKS WELLNESS & REHABILITATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GARETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-987-5954
Mailing Address - Street 1:9350 GREEN PARK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7211
Mailing Address - Country:US
Mailing Address - Phone:314-845-0900
Mailing Address - Fax:314-845-0901
Practice Address - Street 1:9350 GREEN PARK RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7211
Practice Address - Country:US
Practice Address - Phone:314-845-0900
Practice Address - Fax:314-845-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility