Organization
BLOOM COMPASSIONATE RESIDENTIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH MBUEN PMHNP-BC (CEO)
(336) 740-6347
Entity
Organization
Contact information
Practice address
4102 PARAPET CT, FREDERICKSBURG, VA 22408-2564
(571) 518-8036
(186) 692-9826
Mailing address
4102 PARAPET CT, FREDERICKSBURG, VA 22408-2564
(571) 518-8036
(186) 692-9826
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/11/2025
Last updated
12/11/2025
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