MEDICARE: BLBLOOMCARE, 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
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1487546206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLBLOOMCARE, INC

Provider Business Mailing Address
First Line	:	12117 MERRITT VILLA
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4483
Country	:	US
Telephone Number	:	832-614-1323
Fax Number	:

Provider Business Practice Location Address
First Line	:	12117 MERRITT VILLA
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4483
Country	:	US
Telephone Number	:	832-614-1323
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. LA SEASON OLAYANDE
Credential	:
Telephone Number	:	832-614-1323

Provider Enumeration Date	:	07/16/2025
Last Update Date	:	07/16/2025

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