NPIMap

Organization Active NPI

Broador Horizon, Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Glen Burnie, MD
National Provider Identifier
1104096130
Registry record updated Mar 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
0290 Issued in MD
Legal business name
BROADOR HORIZON, INC
Practice address
199 Plymouth LN
F
Glen Burnie, MD 21061-5652
Phone
(443) 413-0832
NPI assigned
Mar 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kevin E. Mattison, M.B.A.
Title
Ceo
Phone
(443) 413-0832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 0290 MD Primary

Addresses

Primary practice location

199 Plymouth LN
F
Glen Burnie, MD 21061-5652

Mailing address

199 Plymouth LN
F
Glen Burnie, MD 21061-5652

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204675200000",
    "number": "1104096130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 PLYMOUTH LN",
            "address_2": "F",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 PLYMOUTH LN",
            "address_2": "F",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615652",
            "telephone_number": "443-413-0832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADOR HORIZON, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-05",
        "last_updated": "2008-03-05",
        "status": "A",
        "authorized_official_last_name": "MATTISON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "443-413-0832",
        "authorized_official_credential": "M.B.A."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MD",
            "license": "0290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.