Broadmoor Health Care, LLC

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

BROADMOOR HEALTH CARE, LLC

Doing business as

Broadmoor Retirement Community

Practice address

8205 E 22ND St
Tulsa, OK 74129-2839

Phone

(918) 622-2151

Fax

(918) 622-2233

NPI assigned

Jun 19, 2014

Organization subpart

No

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

Authorized official

Name

Judah Bienstock

Title

Managing Member

Phone

(314) 631-3000

Specialties & licenses 1

Addresses

Other names 1

• Broadmoor Retirement Community Doing business as

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

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449014400000",
    "number": "1710391586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8205 E 22ND ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741292839",
            "telephone_number": "918-622-2151",
            "fax_number": "918-622-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8205 E 22ND ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741292839",
            "telephone_number": "918-622-2151",
            "fax_number": "918-622-2233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADMOOR HEALTH CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-19",
        "last_updated": "2015-12-02",
        "status": "A",
        "authorized_official_last_name": "BIENSTOCK",
        "authorized_official_first_name": "JUDAH",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "314-631-3000"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadmoor Retirement Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristin Brooke Bristow, MD
• Brynlee Grace Britt
• April Lynn Brizendine
• Mark Brizendine, RD/LD CNSC
• Kauli Ann Broadhead
• Candis L Broadnax
• Lauren Broadright
• Veneeciea Broadus
• Ezrikai Broam, LCSW, LADC
• Bridget Anne Brock, MS

• Custodial Care Facility in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Custodial Care Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.