1013820992 NPI number — PHOENIX BLOOM FAMILY FOUNDATION, INC.

Table of content: (NPI 1013820992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013820992 NPI number — PHOENIX BLOOM FAMILY FOUNDATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOENIX BLOOM FAMILY FOUNDATION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013820992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 HIDEAWAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017-9775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-307-4540
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 HIDEAWAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-9775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-307-4540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2026

Additional Information

Authorized Official

Authorized Official Last Name:
HACKER
Authorized Official First Name:
TINA
Authorized Official Middle Name:
NICHOLE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
859-307-4540

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com