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General NPI Number Information
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NPI Number | 1568283117
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Entity Type | Organization
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Legal Business Name | BLOOM HOMEHEALTH SOLUTIONS
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 2012 JUSTIN RD
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City | LEWISVILLE
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State | TX
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Zip | 75077
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Country | US
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Telephone | 214-998-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 3039 NOWITZKI WAY APT 3112
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City | DALLAS
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State | TX
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Zip | 75219-7985
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Country | US
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Telephone | 909-918-8922
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YETTA ADELE SAMANTHA ROTH
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Credential |
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Telephone | 909-918-8922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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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 | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 364SH0200X
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Taxonomy Name | Home Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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