Organization
BROADMORE SENIOR LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELANIE NICOLE MIRACLE (ADMINISTRATIVE ASSISTANT)
(423) 764-4622
Entity
Organization
Contact information
Practice address
826 MEADOW VIEW RD, BRISTOL, TN 37620-9535
(423) 764-4622
(423) 764-4822
Mailing address
826 MEADOW VIEW RD, BRISTOL, TN 37620-9535
(423) 764-4622
(423) 764-4822
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ACL0000000119
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A3762000
—
TN
Enumeration date
07/19/2012
Last updated
07/19/2012
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