Healthcare Provider Details

I. General information

NPI: 1487740452
Provider Name (Legal Business Name): BLOOMFIELD WEST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 E IMPERIAL HWY
LYNWOOD CA
90262-3305
US

IV. Provider business mailing address

3333 E IMPERIAL HWY
LYNWOOD CA
90262-3305
US

V. Phone/Fax

Practice location:
  • Phone: 310-638-6691
  • Fax:
Mailing address:
  • Phone: 310-631-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number960000541
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number550001863
License Number StateCA

VIII. Authorized Official

Name: ANA MARIA CANDELAS
Title or Position: AR SYSTEMS MANAGER
Credential:
Phone: 949-740-3454