Healthcare Provider Details

I. General information

NPI: 1710897038
Provider Name (Legal Business Name): BLOOMS HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6117 ARMOR DR
CLINTON MD
20735-3411
US

IV. Provider business mailing address

6117 ARMOR DR
CLINTON MD
20735-3411
US

V. Phone/Fax

Practice location:
  • Phone: 240-422-9959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. VANICIA TAMBU
Title or Position: C.E.O
Credential:
Phone: 240-422-9959