MEDICARE: BLOOMWELL BEHAVIORAL HEALTH INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	106S00000X	Behavior Technician
2	251S00000X	Community/Behavioral Health Agency
3	225100000X	Physical Therapist
4	235Z00000X	Speech-Language Pathologist
5	106E00000X	Assistant Behavior Analyst
6	225X00000X	Occupational Therapist
7	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1740047489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOMWELL BEHAVIORAL HEALTH INC.

Provider Business Mailing Address
First Line	:	382 NE 191ST ST STE 98090
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-3899
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	382 NE 191ST ST STE 98090
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-3899
Country	:	US
Telephone Number	:	501-282-0630
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LOGAN PRATT
Credential	:
Telephone Number	:	501-282-0630

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	01/20/2026

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