Healthcare Provider Details

I. General information

NPI: 1235075086
Provider Name (Legal Business Name): BLOOM HOME ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 W BLOOMFIELD RD
PHOENIX AZ
85029-2538
US

IV. Provider business mailing address

2509 W BLOOMFIELD RD
PHOENIX AZ
85029-2538
US

V. Phone/Fax

Practice location:
  • Phone: 480-577-9460
  • Fax:
Mailing address:
  • Phone: 480-577-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: NKEMAKOLAM MAXWELL IROEGBULAM
Title or Position: MANAGER
Credential:
Phone: 480-577-9460