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General NPI Number Information
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NPI Number | 1093666265
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Entity Type | Organization
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Legal Business Name | BLOOMHAVEN WELLNESS CENTER
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Dates
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Enumeration Date | 02/04/2026
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 5373 W ALABAMA ST STE 204
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City | HOUSTON
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State | TX
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Zip | 77056-5923
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Country | US
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Telephone | 832-466-2215
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Fax |
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Provider Business Mailing Address
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Address Line | 2424 CAPITOL ST APT 1112
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City | HOUSTON
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State | TX
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Zip | 77003-3150
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Country | US
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Telephone | 832-466-2215
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JASMINE N RANDOLPH
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Credential |
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Telephone | 832-730-9817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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