MEDICARE: BLOOM HAVEN THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1366374068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM HAVEN THERAPY LLC

Provider Business Mailing Address
First Line	:	2173 BALCLUTHA LN
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29153-8319
Country	:	US
Telephone Number	:	803-565-2305
Fax Number	:

Provider Business Practice Location Address
First Line	:	2173 BALCLUTHA LN
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29153-8319
Country	:	US
Telephone Number	:	803-565-2305
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SYDNEY OWENS JENNINGS
Credential	:	LISW-CP
Telephone Number	:	803-565-2305

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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Directions to “BLOOM HAVEN THERAPY LLC ” Practice Location

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