Provider Demographics
NPI:1689427130
Name:EMBERS TO BLOOM LLC
Entity type:Organization
Organization Name:EMBERS TO BLOOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMESMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-230-3954
Mailing Address - Street 1:9300 CONROY WINDERMERE RD UNIT 3089
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5121
Mailing Address - Country:US
Mailing Address - Phone:321-895-2676
Mailing Address - Fax:
Practice Address - Street 1:159 CROCKER PARK BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-8147
Practice Address - Country:US
Practice Address - Phone:513-513-6237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty