Healthcare Provider Details

I. General information

NPI: 1235053844
Provider Name (Legal Business Name): BLOOM ROCK CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3953 HAYGOOD MEADOW DR SW
MARIETTA GA
30062-6517
US

IV. Provider business mailing address

3953 HAYGOOD MEADOW DR SW
MARIETTA GA
30062-6517
US

V. Phone/Fax

Practice location:
  • Phone: 404-322-7292
  • Fax:
Mailing address:
  • Phone: 404-322-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTINS EBOMA
Title or Position: ADMINISTRATOR
Credential:
Phone: 404-322-7292