Judy Lynn Broyles
Individual provider Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Gladewater, TX
NPI 1164046637 · NPPES record last updated Dec 14, 2020
Key facts
- NPI
- 1164046637
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- Practice address
- 1088 N Willow Oak Rd
Gladewater, TX 75647-7811 - Phone
- (903) 714-3099
- NPI assigned
- Jun 1, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| B &G Custom Care | Community Based Residential Treatment Facility, Intellectual and/Or Developmental Disabilities | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | |||
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Yes |
Addresses
Primary practice location
1088 N Willow Oak Rd
Gladewater, TX 75647-7811
Mailing address
1088 N Willow Oak Rd
Gladewater, TX 75647-7811
Phone (903) 714-3099
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316559321 | Medicaid | TX |
Other providers in Gladewater, TX
- B &G Custom Care
- Bailey Bettis
- Bewell & Associates LLC
- Sheila R Brinkman
- Laura Ruth Brown
- C.L. Kirby, DDS PLLC
- Tracy Casey
- Stacy Caron Christine
- Patrick Coffey
- Collect Memories at Home LLC
All providers in Gladewater, TX · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.