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General NPI Number Information
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NPI Number | 1811704794
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Entity Type | Organization
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Legal Business Name | BLOOM EARLY INTERVENTION CO, LLC
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Dates
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Enumeration Date | 12/14/2024
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Last Update Date | 12/14/2024
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Provider Practice Location Address
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Address Line | 310 BRYANT BLVD C/O CYNDI VEAL
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City | ROCK HILL
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State | SC
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Zip | 29732-9256
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Country | US
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Telephone | 803-412-9118
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Fax |
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Provider Business Mailing Address
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Address Line | 310 BRYANT BLVD C/O CYNDI VEAL
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City | ROCK HILL
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State | SC
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Zip | 29732-9256
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Country | US
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Telephone | 803-412-9118
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA VEAL
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Credential | EIS
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Telephone | 803-412-9118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 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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