Broadmoor Continuing Care Center LTD. Co.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BROADMOOR CONTINUING CARE CENTER LTD. CO.

Doing business as

The Broadmoor at Creekside Park

Practice address

5665 Creekside Forest Dr
The Woodlands, TX 77389-4969

Phone

(281) 255-8180

Fax

(281) 255-8190

NPI assigned

Nov 20, 2013

Organization subpart

No

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

Authorized official

Name

Lisa M Smith

Title

Legal Assistant/Claims Manager

Phone

(214) 954-4114

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Broadmoor at Creekside Park Doing business as

Locations

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

{
    "created_epoch": "1384905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430352000000",
    "number": "1609206077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2537 GOLDEN BEAR DR",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750062377",
            "telephone_number": "214-954-4114",
            "fax_number": "214-880-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5665 CREEKSIDE FOREST DR",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773894969",
            "telephone_number": "281-255-8180",
            "fax_number": "281-255-8190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADMOOR CONTINUING CARE CENTER LTD. CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-20",
        "last_updated": "2015-04-30",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "LEGAL ASSISTANT/CLAIMS MANAGER",
        "authorized_official_telephone_number": "214-954-4114"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001025592",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Broadmoor at Creekside Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kesia Al Broome, D.C.
• Aimee Kelty Broussard, LCSW

• Skilled Nursing Facility in The Woodlands, TX
• Providers in The Woodlands, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; 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.