Broadstep Academy-Illinois INC

NPI #1104593565 in Marengo, Illinois

Provider Information

NPI Number: 1104593565
Entity Type: Organization
Organization Name: Broadstep Academy-Illinois INC
Primary Specialty: Community Based Residential Treatment Facility, Mental Illness
Enumeration Date: Aug 24, 2021
Last Updated: Aug 25, 2021

Practice Location

Address: 805 THORNAPPLE LN
City: Marengo
State: Illinois
ZIP Code: 60152-3414
Phone: (815) 568-5323

Authorized Official

Name: KEDRIAN COLEMAN
Title: DIRECTOR REVENUE CYCLE
Phone: (919) 709-0197

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Mental Illness	320800000X	Primary

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