Judy Lynn Broyles
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Gladewater, TX. Individual provider (NPI-1).
NPI number1164046637
StatusActive
Last updated in NPPESDec 14, 2020
Details
- NPI
- 1164046637
- Entity type
- Individual (NPI-1)
- Name
- Judy Lynn Broyles
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 1, 2020
- Certification date
- Dec 14, 2020
- Last updated
- Dec 14, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | – | – | Yes |
| 251E00000X | Home Health | – | – |
Practice location
1088 N Willow Oak RdGladewater, TX 75647-7811
Phone 903-714-3099
Mailing address
1088 N Willow Oak RdGladewater, TX 75647-7811
Phone 903-714-3099
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