Broken Arrow, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

BROKEN ARROW, INC.

Practice address

1649 Marion Rd
Bucyrus, OH 44820-3116

Phone

(419) 562-3480

NPI assigned

Nov 17, 2020

Last updated

Nov 17, 2020By 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

Mrs. Jayne Hanning

Title

Director

Phone

(419) 562-3480

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605571200000",
    "number": "1619570231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1649 MARION RD",
            "city": "BUCYRUS",
            "state": "OH",
            "postal_code": "448203116",
            "telephone_number": "419-562-3480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1649 MARION RD",
            "city": "BUCYRUS",
            "state": "OH",
            "postal_code": "448203116",
            "telephone_number": "419-562-3480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROKEN ARROW, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-17",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "HANNING",
        "authorized_official_first_name": "JAYNE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "419-562-3480",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0876842",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan M Branstetter, LPN
• Cynda S Brause, RN
• Tyler Brause, DPT
• Thomas M Britton, OD
• Brett Brodbeck, D.C.
• Morgan Brooke, LSW
• Paula L Brown, CT
• Jackson Brownstein, DPT
• Bucyrus Al, LLC (Trustwell Living at Carlisle Place)
• Bucyrus City

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Bucyrus, OH
• Providers in Bucyrus, OH by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.