1437714532 NPI number — BLOOM BEHAVIORAL HEALTH SERVICES, LLC

Table of content: JANET MARIE BAGGETT RRT (NPI 1174966956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437714532 NPI number — BLOOM BEHAVIORAL HEALTH SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLOOM BEHAVIORAL HEALTH SERVICES, LLC
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:
1437714532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 N JENNIFER WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTERVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93257-9031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-728-3651
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 N N ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULARE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93274-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-656-1800
Provider Business Practice Location Address Fax Number:
559-656-1500
Provider Enumeration Date:
05/03/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ORTEGA
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
562-972-7604

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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