Provider Demographics
NPI:1629952213
Name:BLOOM BIRTH AND WELLNESS CENTER
Entity type:Organization
Organization Name:BLOOM BIRTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-262-7077
Mailing Address - Street 1:28250 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1659
Mailing Address - Country:US
Mailing Address - Phone:616-262-7077
Mailing Address - Fax:616-344-2134
Practice Address - Street 1:28250 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1659
Practice Address - Country:US
Practice Address - Phone:616-262-7077
Practice Address - Fax:616-344-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing