NPIMap

Organization Active NPI

Willowglen Academy

Doing business as Broadstep Academy-Illinois Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Chatham, IL
National Provider Identifier
1437828654
Registry record updated Sep 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
WILLOWGLEN ACADEMY
Doing business as
Broadstep Academy-Illinois Inc
Practice address
622 Garvey LN
Chatham, IL 62629-5086
Phone
(217) 697-8422
NPI assigned
Sep 10, 2021
Last updated
Sep 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2021

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

622 Garvey LN
Chatham, IL 62629-5086

Mailing address

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

Other names 1

  • Broadstep Academy-Illinois Inc Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Broadstep Academy-Illinois Inc39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1631232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1437828654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8521 SIX FORKS RD STE 300",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276155294",
            "telephone_number": "919-709-0197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 GARVEY LN",
            "city": "CHATHAM",
            "state": "IL",
            "postal_code": "626295086",
            "telephone_number": "217-697-8422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWGLEN ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-10",
        "last_updated": "2021-09-10",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "KEDRIAN",
        "authorized_official_title_or_position": "DIRECTOR REVENUE CYCLE",
        "authorized_official_telephone_number": "919-709-0197"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadstep Academy-Illinois Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chatham, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; 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.