Organization
BLOOM EARLY INTERVENTION CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAWO HASSAN FARAH (OWNER)
(952) 212-8614
Entity
Organization
Contact information
Practice address
760 EVERGREEN DR APT 102, BURNSVILLE, MN 55337-4646
(952) 212-8614
Mailing address
760 EVERGREEN DR APT 102, BURNSVILLE, MN 55337-4646
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
04/25/2024
Last updated
04/25/2024
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