Provider Demographics
NPI:1013709351
Name:THE BLOOMING PATH LLC
Entity type:Organization
Organization Name:THE BLOOMING PATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANIEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:CPRS, CHW-II
Authorized Official - Phone:702-670-8900
Mailing Address - Street 1:5546 CAMINO AL NORTE # 2-261
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0805
Mailing Address - Country:US
Mailing Address - Phone:702-483-1230
Mailing Address - Fax:
Practice Address - Street 1:1229 PAVILIONS AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2321
Practice Address - Country:US
Practice Address - Phone:702-483-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty