| Entity Name: | BLOOM PERINATAL SUPPORT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Mar 2023 (2 years ago) |
| Document Number: | L23000156000 |
| FEI/EIN Number | 93-1896710 |
| Address: | 6175 PANTHER DR, MILTON, FL, 32570, UN |
| Mail Address: | 6175 PANTHER DR, MILTON, FL, 32570, UN |
| ZIP code: | 32570 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780416933 | 2024-08-16 | 2024-08-16 | 6175 PANTHER DR, MILTON, FL, 325705443, US | 6175 PANTHER DR, MILTON, FL, 325705443, US | |||||||||||||
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| Phone | +1 850-203-0173 |
Authorized person
| Name | BRIANNA DAVIS |
| Role | OWNER/THERAPIST |
| Phone | 8502030173 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DAVIS BRIANNA | Agent | 6175 PANTHER DR, MILTON, FL, 32570 |
| Name | Role | Address |
|---|---|---|
| DAVIS BRIANNA | Manager | 6175 PANTHER DR, MILTON, FL, 32570 |
| Name | Role | Address |
|---|---|---|
| Pagano Brian | Auth | 29226 Ginnetto Drive, Wesley Chapel, FL, 33543 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-08 |
| Florida Limited Liability | 2023-03-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
