Organization
BROADSTEP ACADEMY-ILLINOIS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEDRIAN COLEMAN (DIRECTOR REVENUE CYCLE)
(919) 709-0197
Entity
Organization
Contact information
Practice address
805 THORNAPPLE LN, MARENGO, IL 60152-3414
(815) 568-5323
Mailing address
8521 SIX FORKS RD STE 300, RALEIGH, NC 27615-5294
(919) 709-0197
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/24/2021
Last updated
08/25/2021
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