Healthcare Provider Details

I. General information

NPI: 1164332516
Provider Name (Legal Business Name): BLOOM HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7151 DELMAR BLVD
SAINT LOUIS MO
63130-4304
US

IV. Provider business mailing address

326 CALLIOPE PL
CHESTERFIELD MO
63017-4400
US

V. Phone/Fax

Practice location:
  • Phone: 314-614-6145
  • Fax:
Mailing address:
  • Phone: 314-614-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY FU
Title or Position: OWNER
Credential:
Phone: 314-614-6145