Healthcare Provider Details

I. General information

NPI: 1699675306
Provider Name (Legal Business Name): BLOOMCARE CONNECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2026
Last Update Date: 11/07/2026
Certification Date: 11/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 N SCHOOL ST
NORMAL IL
61761-1621
US

IV. Provider business mailing address

716 N SCHOOL ST
NORMAL IL
61761-1621
US

V. Phone/Fax

Practice location:
  • Phone: 309-336-3475
  • Fax:
Mailing address:
  • Phone: 309-336-3475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRIANA GARZA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 309-336-3475