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General NPI Number Information
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NPI Number | 1467314328
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Entity Type | Organization
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Legal Business Name | LIFE BLOOM SUPPORT & REFERRAL SERVICES LLC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 101 ARTHUR ST
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City | GREENVILLE
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State | NC
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Zip | 27834-5317
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Country | US
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Telephone | 352-474-8519
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Fax |
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Provider Business Mailing Address
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Address Line | 1306 CLARK ST
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City | GREENVILLE
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State | NC
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Zip | 27834-4056
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Country | US
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Telephone | 352-474-8519
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATALIE SMALL JOHNSON
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Credential |
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Telephone | 352-474-8519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #6
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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 #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #9
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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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