Healthcare Provider Details

I. General information

NPI: 1417779653
Provider Name (Legal Business Name): BALANCE & BLOOM HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49611 MOIESE VALLEY RD # B
RONAN MT
59864-8855
US

IV. Provider business mailing address

49611 MOIESE VALLEY RD # B
RONAN MT
59864-8855
US

V. Phone/Fax

Practice location:
  • Phone: 406-544-5862
  • Fax:
Mailing address:
  • Phone: 406-544-5862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: JU-LIN SIPLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 406-250-2930