| Entity Name: | BLOOM BEHAVIOR SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 05 Dec 2017 (7 years ago) |
| Document Number: | L17000248423 |
| FEI/EIN Number | 82-3637495 |
| Mail Address: | 7175 Foster Lane, Orlando, FL 32818 |
| Address: | 6239 edgewater drive, suite N4, Orlando, FL 32810 |
| ZIP code: | 32810 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790291649 | 2017-12-14 | 2024-05-28 | 6239 EDGEWATER DR STE N4, ORLANDO, FL, 328104736, US | 6239 EDGEWATER DR STE N4, ORLANDO, FL, 328104736, US | |||||||||||||||||||||
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| Phone | +1 407-900-5532 |
| Fax | 3212440645 |
Authorized person
| Name | MIA RICHARDS |
| Role | OWNER |
| Phone | 4077584948 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 018854500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RICHARDS, MIA | Agent | 7175 Foster Lane, Orlando, FL 32818 |
| Name | Role | Address |
|---|---|---|
| RICHARDS, MIA | Manager | 7175 Foster Lane, Orlando, FL 32818 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-02 | 6239 edgewater drive, suite N4, Orlando, FL 32810 | No data |
| CHANGE OF MAILING ADDRESS | 2021-08-23 | 6239 edgewater drive, suite N4, Orlando, FL 32810 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-15 | 7175 Foster Lane, Orlando, FL 32818 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-16 |
| ANNUAL REPORT | 2023-03-30 |
| ANNUAL REPORT | 2022-02-21 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-03-08 |
| ANNUAL REPORT | 2019-01-14 |
| ANNUAL REPORT | 2018-07-23 |
| Florida Limited Liability | 2017-12-05 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
