Healthcare Provider Details

I. General information

NPI: 1124810288
Provider Name (Legal Business Name): BLOOMBRIDGE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 LARPENTEUR AVE W STE 100
LAUDERDALE MN
55113-5278
US

IV. Provider business mailing address

2520 LARPENTEUR AVE W STE 100
LAUDERDALE MN
55113-5278
US

V. Phone/Fax

Practice location:
  • Phone: 614-981-5367
  • Fax:
Mailing address:
  • Phone: 614-981-5367
  • 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: ADEN ISMAIL ISSE
Title or Position: OWNER
Credential:
Phone: 614-981-5367