Organization
WILLOWGLEN ACADEMY
Active
Other names
Broadstep Academy-Illinois Inc
Organization subpart
No
Provider details
NPI number
Authorized official
KEDRIAN COLEMAN (DIRECTOR REVENUE CYCLE)
(919) 709-0197
Entity
Organization
Contact information
Practice address
1971 W NAVAJO DR, FREEPORT, IL 61032-7133
(815) 232-7616
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
09/09/2021
Last updated
09/09/2021
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