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General NPI Number Information
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NPI Number | 1013709351
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Entity Type | Organization
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Legal Business Name | THE BLOOMING PATH LLC
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 1229 PAVILIONS AVE
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-2321
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Country | US
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Telephone | 702-483-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 5546 CAMINO AL NORTE # 2-261
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-0805
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Country | US
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Telephone | 702-483-1230
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Fax |
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Authorized Official
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Title or Position | FOUNDER & MANAGING MEMBER
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Name | ANIEDRA WELLS
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Credential | CPRS, CHW-II
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Telephone | 702-670-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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