Blooming Pathways Behavioral Health Group LLC
Behavior Analyst in Moreno Valley, CA. Organization (NPI-2).
NPI number1104745512
StatusActive
Last updated in NPPESJul 11, 2026
Details
- NPI
- 1104745512
- Entity type
- Organization (NPI-2)
- Legal business name
- Blooming Pathways Behavioral Health Group LLC
- Organization subpart
- No
- Enumeration date
- Jul 11, 2026
- Certification date
- Jul 11, 2026
- Last updated
- Jul 11, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103K00000X | Behavior Analyst | – | – | Yes |
Practice location
13400 Elsworth St Apt 108Moreno Valley, CA 92553-8437
Phone 951-796-0048
Mailing address
13400 Elsworth St Apt 108Moreno Valley, CA 92553-8437
Authorized official
Simone Angelique Jackson
Ceo
9517960048
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