Bloom Early Intervention Center LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

BLOOM EARLY INTERVENTION CENTER LLC

Practice address

760 Evergreen Dr Apt 102
Burnsville, MN 55337-4646

Phone

(952) 212-8614

NPI assigned

Apr 25, 2024

Organization subpart

No

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

Authorized official

Name

Hawo Hassan Farah

Title

Owner

Phone

(952) 212-8614

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1714003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1346096864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 EVERGREEN DR APT 102",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 EVERGREEN DR APT 102",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374646",
            "telephone_number": "952-212-8614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM EARLY INTERVENTION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-25",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "FARAH",
        "authorized_official_first_name": "HAWO",
        "authorized_official_middle_name": "HASSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-212-8614"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Early Intervention Provider Agency in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Early Intervention Provider Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 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.