Bloom & Beyond LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

BLOOM & BEYOND LLC

Practice address

3081 Old Washington Rd
Waldorf, MD 20601-3122

Phone

(240) 803-5263

NPI assigned

Jan 2, 2023

Organization subpart

No

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

Authorized official

Name

Shante Lane, M.S. EDUCATION

Title

Owner

Phone

(240) 803-5263

Specialties & licenses 1

Addresses

Other names 1

• Bloom & Beyond LLC Former legal business name

Locations

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

{
    "created_epoch": "1672617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672617600000",
    "number": "1215640693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3081 OLD WASHINGTON RD",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206013122",
            "telephone_number": "240-803-5263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3081 OLD WASHINGTON RD",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206013122",
            "telephone_number": "240-803-5263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM & BEYOND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-02",
        "last_updated": "2023-01-02",
        "certification_date": "2022-12-31",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "SHANTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-803-5263",
        "authorized_official_credential": "M.S. EDUCATION"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloom & Beyond LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2023; 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.