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General NPI Number Information
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NPI Number | 1235075086
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Entity Type | Organization
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Legal Business Name | BLOOM HOME ASSISTED LIVING
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Dates
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Enumeration Date | 04/24/2026
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 2509 W BLOOMFIELD RD
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City | PHOENIX
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State | AZ
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Zip | 85029-2538
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Country | US
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Telephone | 480-577-9460
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Fax |
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Provider Business Mailing Address
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Address Line | 2509 W BLOOMFIELD RD
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City | PHOENIX
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State | AZ
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Zip | 85029-2538
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Country | US
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Telephone | 480-577-9460
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | NKEMAKOLAM MAXWELL IROEGBULAM
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Credential |
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Telephone | 480-577-9460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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