Healthcare Provider Details

I. General information

NPI: 1295649903
Provider Name (Legal Business Name): BLOOM & BELONG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 10TH ST N APT 2211
FARGO ND
58102-4782
US

IV. Provider business mailing address

220 10TH ST N APT 2211
FARGO ND
58102-4782
US

V. Phone/Fax

Practice location:
  • Phone: 701-320-4231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JADE MARIE OLSCHLAGER
Title or Position: OWNER
Credential:
Phone: 701-320-4231