Provider Demographics
NPI:1982426771
Name:BLOOM HEALTH LLC
Entity type:Organization
Organization Name:BLOOM HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER, SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:352-580-6573
Mailing Address - Street 1:4215 NW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1412
Mailing Address - Country:US
Mailing Address - Phone:786-514-9793
Mailing Address - Fax:
Practice Address - Street 1:5310 NW 8TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4468
Practice Address - Country:US
Practice Address - Phone:352-580-6573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service