Organization
BLOOM AT WILLOW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT KANTOR (PRESIDENT)
(312) 282-4050
Entity
Organization
Contact information
Practice address
2725 LAKE CIRCLE DR, INDIANAPOLIS, IN 46268-4931
(317) 334-9400
Mailing address
260 E BROWN ST STE 315, BIRMINGHAM, MI 48009-6232
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
08/18/2023
Last updated
08/18/2023
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