Healthcare Provider Details

I. General information

NPI: 1568394757
Provider Name (Legal Business Name): BLOOM VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17728 OAKMONT DR STE 213
OMAHA NE
68136-0010
US

IV. Provider business mailing address

12948 CHANDLER ST
OMAHA NE
68138-6016
US

V. Phone/Fax

Practice location:
  • Phone: 402-604-1063
  • Fax:
Mailing address:
  • Phone: 402-604-1063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATIE BLOOM
Title or Position: SOCIAL WORKER, THERAPIST
Credential: LIMHP, CMSW
Phone: 402-604-1063