MEDICARE: BLOOM CARE GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1649080672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM CARE GROUP LLC

Provider Business Mailing Address
First Line	:	11300 IRON BRIDGE RD STE B
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1428
Country	:	US
Telephone Number	:	804-707-7284
Fax Number	:	804-710-2024

Provider Business Practice Location Address
First Line	:	11300 IRON BRIDGE RD STE B
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1428
Country	:	US
Telephone Number	:	804-707-7284
Fax Number	:	804-710-2024

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MISS TENYAH JOHNSON
Credential	:
Telephone Number	:	804-707-7284

Provider Enumeration Date	:	01/11/2025
Last Update Date	:	01/11/2025

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