Healthcare Provider Details

I. General information

NPI: 1952172504
Provider Name (Legal Business Name): BLOOM COORDINATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 E LEWIS LN
NAMPA ID
83686-9076
US

IV. Provider business mailing address

PO BOX 3856
NAMPA ID
83653-3717
US

V. Phone/Fax

Practice location:
  • Phone: 208-880-4027
  • Fax:
Mailing address:
  • Phone: 208-880-4027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MATTHEW WARD
Title or Position: MANAGING MEMBER
Credential:
Phone: 208-598-8913