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General NPI Number Information
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NPI Number | 1851231567
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Entity Type | Organization
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Legal Business Name | LIFE BLOOMS HOME, LLC
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 3501 NW 212 STREET
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City | MIAMI GARDENS
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State | FL
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Zip | 33056
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Country | US
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Telephone | 305-785-7259
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Fax | 305-703-6169
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Provider Business Mailing Address
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Address Line | 3501 NW 212 STREET
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City | MIAMI GARDENS
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State | FL
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Zip | 33056
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Country | US
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Telephone | 305-785-7259
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Fax | 305-703-6169
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | IAISA BLOOM
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Credential | DNP, APRN, PMHNP-BC,
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Telephone | 305-785-7259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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