Healthcare Provider Details

I. General information

NPI: 1639021272
Provider Name (Legal Business Name): BLOOMING HEARTS ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 MONTGOMERY RD STE 102
NAPERVILLE IL
60564-9542
US

IV. Provider business mailing address

4425 MONTGOMERY RD STE 102
NAPERVILLE IL
60564-9542
US

V. Phone/Fax

Practice location:
  • Phone: 331-666-2117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MUHAMMAD ASIM S KHAN
Title or Position: CEO
Credential:
Phone: 331-666-2117