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NPI Code Detail

MEDICARE: BLOOMWELL BEHAVIORAL HEALTH INC.

MEDICARE: BLOOMWELL BEHAVIORAL HEALTH INC.
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
1225100000XPhysical Therapist
2106S00000XBehavior Technician
3235Z00000XSpeech-Language Pathologist
4225X00000XOccupational Therapist
5103K00000XBehavior Analyst

General Provider Information

NPI Number : 1386455954
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLOOMWELL BEHAVIORAL HEALTH INC.
Provider Business Mailing Address
First Line : 382 NE 191ST ST STE 98090
Second Line :
City : MIAMI
State : FL
Zip : 33179-3899
Country : US
Telephone Number : 501-282-0630
Fax Number : 919-561-6112
Provider Business Practice Location Address
First Line : 613 N 204TH AVENUE CIR
Second Line :
City : ELKHORN
State : NE
Zip : 68022-1830
Country : US
Telephone Number : 402-819-4059
Fax Number : 919-561-6112
Authorized Official
Title or Position : CEO
Name : MR. LOGAN PRATT
Credential : CEO
Telephone Number : 612-201-2468
Provider Enumeration Date : 01/14/2025
Last Update Date : 10/16/2025

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