# BROADMOOR ONE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790040327
- **Authorized official:** MR. MAX COLE (OWNER)
- **Authorized official phone:** (316) 683-0562

## Contact information

- **Practice address:** 2119 N BROADMOOR ST, WICHITA, KS 67206-1028
- **Practice address phone:** (316) 260-3625
- **Mailing address:** 9435 E CENTRAL AVE STE 200, WICHITA, KS 67206-2552
- **Mailing address phone:** (316) 683-0562

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | B087182 | KS | Yes |

## Other

- **Enumeration date:** 07/10/2012
- **Last updated:** 07/10/2012