Organization
BLOOM MED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK GOFORTH MHPFNP (OWNER)
(520) 904-7987
Entity
Organization
Contact information
Practice address
2301 S STEARMAN DR, CHANDLER, AZ 85286-2263
(520) 800-5676
Mailing address
2301 S STEARMAN DR, CHANDLER, AZ 85286-2263
(520) 800-5676
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
07/08/2025
Last updated
07/08/2025
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