Broadstep Academy-Illinois INC
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Freeport, IL. Organization (NPI-2).
Details
- NPI
- 1982808895
- Entity type
- Organization (NPI-2)
- Legal business name
- Broadstep Academy-Illinois INC
- Organization subpart
- No
- Enumeration date
- Jun 13, 2007
- Certification date
- Aug 25, 2021
- Last updated
- Aug 25, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | 036004 | IL | Yes |
Practice location
833 S 16th AveFreeport, IL 61032-5921
Phone 815-232-1616
Mailing address
701 W Lamm RdFreeport, IL 61032-9630
Phone 815-233-6162 · Fax 815-233-6167
Authorized official
Kedrian Coleman
Director Revenue Cycle
9197090197
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