Healthcare Provider Details

I. General information

NPI: 1366285736
Provider Name (Legal Business Name): BOOM INVESTMENTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 NORTH MONROE
TALLAHASSEE FL
32303
US

IV. Provider business mailing address

1733 NORTH MONROE STREET SUITE 3
TALLAHASSEE FL
32303
US

V. Phone/Fax

Practice location:
  • Phone: 850-938-9653
  • Fax:
Mailing address:
  • Phone: 850-938-9653
  • Fax:

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 Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE BRUNSON
Title or Position: MANAGER
Credential:
Phone: 850-938-9653