Healthcare Provider Details

I. General information

NPI: 1619675600
Provider Name (Legal Business Name): ABLOOM HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 W ELLIOT RD STE 102
TEMPE AZ
85284-1311
US

IV. Provider business mailing address

51 W ELLIOT RD STE 102
TEMPE AZ
85284-1311
US

V. Phone/Fax

Practice location:
  • Phone: 480-590-0020
  • Fax: 480-590-0809
Mailing address:
  • Phone: 480-590-0020
  • Fax: 480-590-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MATTIE GAFFNEY
Title or Position: CEO
Credential:
Phone: 480-590-0020