Provider Demographics
NPI:1659260057
Name:EVERBLOOM INSTITUTE LLC
Entity type:Organization
Organization Name:EVERBLOOM INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMRIIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMATAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-702-7316
Mailing Address - Street 1:913 PLYMOUTH AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-4069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:913 PLYMOUTH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-4069
Practice Address - Country:US
Practice Address - Phone:612-702-7316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency