Healthcare Provider Details

I. General information

NPI: 1144042516
Provider Name (Legal Business Name): BLOOMING QUEENS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MARSHALL AVE
NEWPORT NEWS VA
23607-3502
US

IV. Provider business mailing address

416 TERRYWOOD DR
SUFFOLK VA
23434-4449
US

V. Phone/Fax

Practice location:
  • Phone: 757-232-9657
  • Fax:
Mailing address:
  • Phone: 757-232-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name: TENEE BELL
Title or Position: OWNER/CEO
Credential:
Phone: 757-232-9657