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Organization

BROADMOOR ONE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MAX COLE (OWNER)
(316) 683-0562
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
B087182
KS

Other

Enumeration date
07/10/2012
Last updated
07/10/2012
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