Healthcare Provider Details

I. General information

NPI: 1851231567
Provider Name (Legal Business Name): LIFE BLOOMS HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 NW 212 STREET
MIAMI GARDENS FL
33056
US

IV. Provider business mailing address

3501 NW 212 STREET
MIAMI GARDENS FL
33056
US

V. Phone/Fax

Practice location:
  • Phone: 305-785-7259
  • Fax: 305-703-6169
Mailing address:
  • Phone: 305-785-7259
  • Fax: 305-703-6169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: IAISA BLOOM
Title or Position: OWNER/OPERATOR
Credential: DNP, APRN, PMHNP-BC,
Phone: 305-785-7259