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General NPI Number Information
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NPI Number | 1790419596
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Entity Type | Organization
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Legal Business Name | BLOOMING THERAPEUTIC GARDEN LLC
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 809 W 177TH ST APT 3A
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City | NEW YORK
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State | NY
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Zip | 10033-6600
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Country | US
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Telephone | 212-795-7571
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Fax | 212-795-7571
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Provider Business Mailing Address
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Address Line | 809 W 177TH ST APT 3A
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City | NEW YORK
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State | NY
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Zip | 10033-6600
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Country | US
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Telephone | 212-795-7571
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Fax | 212-795-7571
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Authorized Official
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Title or Position | OWNER/QUALITY ASSURANCE PERSONNEL
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Name | JANNA CRUZ
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Credential | CCC-SLP, TSSLD/BE
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Telephone | 212-795-7571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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