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General NPI Number Information
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NPI Number | 1033014311
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Entity Type | Organization
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Legal Business Name | BLOOM COMMUNITY SUPPORTS LLC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 9111 CROSS PARK DRIVE D200 STE 258
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City | KNOXVILLE
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State | TN
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Zip | 37923
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Country | US
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Telephone | 865-455-5792
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Fax |
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Provider Business Mailing Address
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Address Line | 9111 CROSS PARK DRIVE D200 STE 258
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City | KNOXVILLE
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State | TN
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Zip | 37923
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Country | US
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Telephone | 865-455-5792
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | FAUSTIN BUSANE
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Credential |
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Telephone | 865-455-5792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | NULL
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