Provider Demographics
NPI:1154665966
Name:BROADUS, ROSE ANN
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:ANN
Last Name:BROADUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 MCBRIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127
Mailing Address - Country:US
Mailing Address - Phone:740-751-0443
Mailing Address - Fax:
Practice Address - Street 1:3926 MCBRIDE AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127
Practice Address - Country:US
Practice Address - Phone:740-751-0443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide