Bloom Children'S Developmental Services, LLC

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

BLOOM CHILDREN'S DEVELOPMENTAL SERVICES, LLC

Practice address

10314 N Blacktail Ave
Boise, ID 83714-9696

Phone

(208) 312-0891

NPI assigned

May 29, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kayla Dawn Makar

Title

Owner

Phone

(208) 312-0891

Specialties & licenses 1

Addresses

Other names 1

• Bloom Children's Developmental Services, LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719619200000",
    "number": "1073353967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10314 N BLACKTAIL AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837149696",
            "telephone_number": "208-312-0891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10314 N BLACKTAIL AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837149696",
            "telephone_number": "208-312-0891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM CHILDREN'S DEVELOPMENTAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-29",
        "last_updated": "2024-06-29",
        "certification_date": "2024-06-29",
        "status": "A",
        "authorized_official_last_name": "MAKAR",
        "authorized_official_first_name": "KAYLA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-312-0891"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloom Children's Developmental Services, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bloom Children's Developmental Services, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brittany Blockman, MD
• Grayson Blom, D.C.
• Heidi Rae Blomberg, LMSW
• Jason Blomquist
• Cara Lorena Bloodworth, NNP
• Bloom Counseling and Consulting
• Bloom Idaho LLC
• Bloom Integrative Therapy
• Bloom Speech and Voice Therapy LLC
• Lance Elden Bloom, O.D.

• Developmental Disabilities Clinic/Center in Boise, ID
• Providers in Boise, ID by specialty
• Developmental Disabilities Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.