Bloom Behavioral Community

Primary specialty

Assistant Behavior AnalystTaxonomy code 106E00000X

Legal business name

BLOOM BEHAVIORAL COMMUNITY

Doing business as

Bloom Behavioral Community

Practice address

819 W San Miguel Ave
Phoenix, AZ 85013-1744

Phone

(602) 434-2612

NPI assigned

Sep 10, 2018

Organization subpart

Yes

Parent organization

IRIS HOUSE ASSISTED LIVING, LLCAs reported in NPPES

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

Authorized official

Name

Ms. Jeannette L Everette

Title

Administrator

Phone

(602) 434-2612

Specialties & licenses 1

Addresses

Other names 1

• Bloom Behavioral Community Doing business as

Part of

Bloom Behavioral Community

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

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536537600000",
    "number": "1639652266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 W SAN MIGUEL AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850131744",
            "telephone_number": "602-434-2612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 W SAN MIGUEL AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850131744",
            "telephone_number": "602-434-2612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM BEHAVIORAL COMMUNITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IRIS HOUSE ASSISTED LIVING, LLC",
        "enumeration_date": "2018-09-10",
        "last_updated": "2018-09-10",
        "status": "A",
        "authorized_official_last_name": "EVERETTE",
        "authorized_official_first_name": "JEANNETTE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "602-434-2612",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloom Behavioral Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assistant Behavior Analyst in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Assistant Behavior Analyst in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2018; 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.