Organization
BLOOM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARAE JACKSON (DIRECTOR)
(623) 296-2943
Entity
Organization
Contact information
Practice address
114 W MAIN ST STE 35, MESA, AZ 85201-7310
(623) 296-2943
Mailing address
114 W MAIN ST STE 35, MESA, AZ 85201-7310
(623) 296-2943
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
251E00000X
Home Health Agency
—
—
251G00000X
Community Based Hospice Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
332U00000X
Home Delivered Meals
—
—
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
09/29/2025
Last updated
09/29/2025
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