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General NPI Number Information
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NPI Number | 1639033871
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Entity Type | Organization
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Legal Business Name | BLOOM COMPASSIONATE RESIDENTIAL SERVICES LLC
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Dates
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Enumeration Date | 12/11/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 4102 PARAPET CT
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-2564
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Country | US
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Telephone | 571-518-8036
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Fax | 186-692-9826
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Provider Business Mailing Address
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Address Line | 4102 PARAPET CT
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-2564
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Country | US
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Telephone | 571-518-8036
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Fax | 186-692-9826
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Authorized Official
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Title or Position | CEO
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Name | MR. KENNETH MBUEN
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Credential | PMHNP-BC
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Telephone | 336-740-6347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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