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Broadstep Academy-Illinois Inc

Organization Active NPI Mental Illness Community Based Residential Treatment Facility · Marengo, IL

NPI 1104593565 · NPPES record last updated Aug 25, 2021

Key facts

NPI
1104593565
Entity type
Organization (NPI type 2)
Primary specialty
Mental Illness Community Based Residential Treatment Facility 320800000X
Legal business name
BROADSTEP ACADEMY-ILLINOIS INC
Practice address
805 Thornapple LN
Marengo, IL 60152-3414
Phone
(815) 568-5323
NPI assigned
Aug 24, 2021
Organization subpart
No

Authorized official

Name
Kedrian Coleman
Title
Director Revenue Cycle
Phone
(919) 709-0197

Corporate family (same tax ID) 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

National Provider Directory

Tax ID family
Broadstep Academy-Illinois Inc (39 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Yes

Addresses

Primary practice location

805 Thornapple LN
Marengo, IL 60152-3414

Mailing address

8521 Six Forks Rd Ste 300
Raleigh, NC 27615-5294
Phone (919) 709-0197

Other providers in Marengo, IL

All providers in Marengo, IL · Mental Illness Community Based Residential Treatment Facility in Illinois

Sources for this page

Verify at the official NPI Registry.