Provider Demographics
NPI:1841161908
Name:BLOEMFONTEIN CARE SERVICES LLC
Entity type:Organization
Organization Name:BLOEMFONTEIN CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBECK
Authorized Official - Middle Name:CELYNE
Authorized Official - Last Name:TEBID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-669-6604
Mailing Address - Street 1:7117 LILAC DR
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084-3752
Mailing Address - Country:US
Mailing Address - Phone:325-669-6604
Mailing Address - Fax:
Practice Address - Street 1:7117 LILAC DR
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084-3752
Practice Address - Country:US
Practice Address - Phone:325-669-6604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services