Broadmore Senior Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

ACL0000000119 Issued in TN

Legal business name

BROADMORE SENIOR LIVING

Practice address

826 Meadow View Rd
Bristol, TN 37620-9535

Phone

(423) 764-4622

Fax

(423) 764-4822

NPI assigned

Jul 19, 2012

Last updated

Jul 19, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Melanie Nicole Miracle

Title

Administrative Assistant

Phone

(423) 764-4622

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1342656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342656000000",
    "number": "1346595964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 MEADOW VIEW RD",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376209535",
            "telephone_number": "423-764-4622",
            "fax_number": "423-764-4822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 MEADOW VIEW RD",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376209535",
            "telephone_number": "423-764-4622",
            "fax_number": "423-764-4822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADMORE SENIOR LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-19",
        "last_updated": "2012-07-19",
        "status": "A",
        "authorized_official_last_name": "MIRACLE",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "423-764-4622"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TN",
            "license": "ACL0000000119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A3762000",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bristol Surgery Center
• Bristol Surgery Center, LLC
• Bristol Surgical Associates PC
• Bristol Urological Associates, P.C.
• Ronald Mitchell Brizendine, LCSW
• Andrew Brockmyre, MD
• Amanda Gail Brotherton, MED
• Heather Deeann Brown, PA-C
• Margaret H Brown
• Sherri Lynn Brown, OTR/L

• Assisted Living Facility in Bristol, TN
• Providers in Bristol, TN by specialty
• Assisted Living Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; 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.