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BLOOM OF GRACE REHAB LLC NPI 1558861120


NPI Information

NPI: 1558861120
Provider Name: BLOOM OF GRACE REHAB LLC

Doing Business As: SUREST PATH RECOVERY CENTER OF BLOOMVILLE

Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization

CLIA Number: 36D2148088

Address:
22 CLINTON ST
BLOOMVILLE, OH
ZIP 44818
Phone: (419) 983-4100
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BLOOM OF GRACE REHAB LLC is a substance abuse rehabilitation facility in Bloomville, OH. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. BLOOM OF GRACE REHAB LLC NPI is 1558861120. The provider is registered as an organization entity type.
The provider Is Doing Business As Surest Path Recovery Center Of Bloomville.

The provider's business location address is:

22 CLINTON ST
BLOOMVILLE, OH
ZIP 44818-399
Phone: (419) 983-4100
Fax: (419) 983-4103

The provider's authorized official is Kathy Kay Hunt .
The authorized official title is Administrator and has the following contact phone number (419) 332-3378.

The CLIA number assigned to this NPI record is 36D2148088 - skilled nursing/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/20/2018 and was last updated on 8/10/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1324500000XSubstance Abuse Rehabilitation FacilityYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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