Healthcare Provider Details

I. General information

NPI: 1700799079
Provider Name (Legal Business Name): BLOOM HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 RIVERWOOD CT
MANSFIELD TX
76063-2272
US

IV. Provider business mailing address

707 RIVERWOOD CT
MANSFIELD TX
76063-2272
US

V. Phone/Fax

Practice location:
  • Phone: 972-404-6542
  • Fax:
Mailing address:
  • Phone: 972-404-6542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AGWESIP EMMACULATE
Title or Position: ADMINISTRATOR
Credential:
Phone: 972-404-6542