Provider Demographics
NPI:1861240970
Name:B BROADBENT LLC
Entity type:Organization
Organization Name:B BROADBENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROADBENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-249-1581
Mailing Address - Street 1:1090 SPRINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2691
Mailing Address - Country:US
Mailing Address - Phone:702-249-1581
Mailing Address - Fax:
Practice Address - Street 1:1090 SPRINGWOOD LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2691
Practice Address - Country:US
Practice Address - Phone:702-249-1581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care