Healthcare Provider Details

I. General information

NPI: 1649090135
Provider Name (Legal Business Name): BLOOMING AGES ADHC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 N D ST
SAN BERNARDINO CA
92401-1422
US

IV. Provider business mailing address

455 N D ST
SAN BERNARDINO CA
92401-1422
US

V. Phone/Fax

Practice location:
  • Phone: 909-885-9965
  • Fax: 909-363-9932
Mailing address:
  • Phone: 909-885-9965
  • Fax: 909-363-9932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SONA HOVAKIMYAN
Title or Position: CEO
Credential:
Phone: 909-885-9965