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General NPI Number Information
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NPI Number | 1780088609
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Entity Type | Organization
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Legal Business Name | BLOOM BEHAVIORAL SOLUTIONS
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 997 ATLANTIC BLVD
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-3311
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Country | US
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Telephone | 904-647-1849
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Fax | 904-647-2625
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Provider Business Mailing Address
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Address Line | 997 ATLANTIC BLVD
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-3311
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Country | US
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Telephone | 904-647-1849
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Fax | 904-647-2625
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Authorized Official
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Title or Position | CEO
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Name | GENEVIEVE HICKEY COVINGTON
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Credential |
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Telephone | 904-647-1849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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