Healthcare Provider Details

I. General information

NPI: 1710117585
Provider Name (Legal Business Name): BLOOM ADULT DAY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4360 WARM SPRINGS RD
COLUMBUS GA
31909-5481
US

IV. Provider business mailing address

4360 WARM SPRINGS RD
COLUMBUS GA
31909-5481
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-4324
  • Fax: 706-507-0731
Mailing address:
  • Phone: 706-221-4324
  • Fax: 706-507-0731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC000207
License Number StateGA

VIII. Authorized Official

Name: JOANN HASSELL
Title or Position: OWNER/CEO
Credential:
Phone: 706-221-4324