Healthcare Provider Details

I. General information

NPI: 1841102340
Provider Name (Legal Business Name): MEADOWS BLOOM ABA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 GLENFIELD AVE
GLENOLDEN PA
19036-2402
US

IV. Provider business mailing address

513 GLENFIELD AVE
GLENOLDEN PA
19036-2402
US

V. Phone/Fax

Practice location:
  • Phone: 267-403-9851
  • Fax:
Mailing address:
  • Phone: 267-403-9851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PROMISE CHUKWUEBUKA MBAGWU
Title or Position: OWNER
Credential:
Phone: 267-403-9851