Broadwater Community Care Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

950000051 Issued in CA

Legal business name

BROADWATER COMMUNITY CARE CENTER, LLC

Practice address

2335 Mountain Ave
Duarte, CA 91010-3559

Phone

(626) 357-3207

Fax

(626) 303-1113

NPI assigned

Apr 28, 2008

Organization subpart

Yes

Parent organization

PARKSTONE HOLDINGS, LLCAs reported in NPPES

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

Authorized official

Name

Mr. Doug Easton

Title

Managing Member

Phone

(702) 308-7191

Specialties & licenses 1

Addresses

Other names 1

• Community Care Center Doing business as

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209340800000",
    "number": "1639344898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2335 MOUNTAIN AVE",
            "city": "DUARTE",
            "state": "CA",
            "postal_code": "910103559",
            "telephone_number": "626-357-3207",
            "fax_number": "626-303-1113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2335 MOUNTAIN AVE",
            "city": "DUARTE",
            "state": "CA",
            "postal_code": "910103559",
            "telephone_number": "626-357-3207",
            "fax_number": "626-303-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWATER COMMUNITY CARE CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARKSTONE HOLDINGS, LLC",
        "enumeration_date": "2008-04-28",
        "last_updated": "2008-04-28",
        "status": "A",
        "authorized_official_last_name": "EASTON",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "702-308-7191",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "950000051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mari Bozoghlanian, MD
• Rachel Brady, LCSW, MPH
• Adam Phillip Gordon Braun, MD
• Gabriela Bravo, LCSW
• Deborah A. Briseno-Toomey, MSN, PNP
• Yovana Graciela Bruno, MD
• Andrea Marie Bubbert
• Justine Jade Buchholz, FNP-BC
• Lihua Elizabeth Budde, MD, PHD
• Bueno and Sons Inc.

• Skilled Nursing Facility in Duarte, CA
• Providers in Duarte, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; 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.