Organization
BLOOMING PERSONAL DEVELOPMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQULENE TRINETTE TARVER (OWNER/ PROGRAM ADMINISTRATOR)
(904) 536-4318
Entity
Organization
Contact information
Practice address
1730 SHADOWOOD LN STE 370, JACKSONVILLE, FL 32207-1133
(904) 536-4318
Mailing address
1730 SHADOWOOD LN STE 370, JACKSONVILLE, FL 32207-1133
(904) 536-4318
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/10/2023
Last updated
10/16/2023
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