NPI Code Detail JSON Logo

1578416137 NPI number — BLOOM CONNECT & WELLNESS CENTER PLL

NPI Number: 1578416137
Health Care Provider/Practitioner: BLOOM CONNECT & WELLNESS CENTER PLL

Information about “1578416137” NPI (BLOOM CONNECT & WELLNESS CENTER PLL) exists in 1578416137 in HTML format HTML  |  1578416137 in plain Text format TXT  |  1578416137 in PDF (Portable Document Format) PDF  |  1578416137 in an XML format XML  formats.

NPI Number : 1578416137 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578416137",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BLOOM CONNECT & WELLNESS CENTER PLL",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4102 PARAPET CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FREDERICKSBURG",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22408-2564",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "571-518-8036",
    "MailingAddressFaxNumber": "540-208-1679",
    "FirstLinePracticeLocationAddress": "10562 TATTERSALL DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MANASSAS",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "20112-2407",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "571-518-8036",
    "PracticeLocationAddressFaxNumber": "540-208-1679",
    "EnumerationDate": "02/16/2026",
    "LastUpdateDate": "02/16/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MBUEN",
    "AuthorizedOfficialFirstName": "KENNETH",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO/FOUNDER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PMHNP-BC",
    "AuthorizedOfficialTelephoneNumber": "336-740-6347",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0801X",
        "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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