Broadmoor One LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

B087182 Issued in KS

Legal business name

BROADMOOR ONE LLC

Practice address

2119 N Broadmoor St
Wichita, KS 67206-1028

Phone

(316) 260-3625

NPI assigned

Jul 10, 2012

Last updated

Jul 10, 2012By 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

Mr. Max Cole

Title

Owner

Phone

(316) 683-0562

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341878400000",
    "number": "1790040327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9435 E CENTRAL AVE STE 200",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672062552",
            "telephone_number": "316-683-0562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2119 N BROADMOOR ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672061028",
            "telephone_number": "316-260-3625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADMOOR ONE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-10",
        "last_updated": "2012-07-10",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "MAX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "316-683-0562",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "KS",
            "license": "B087182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Wichita, KS
• Providers in Wichita, KS by specialty
• Adult Care Home Facility in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2012; 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.