Provider Demographics
NPI:1407470933
Name:BROADWAY HEALTH LLC
Entity Type:Organization
Organization Name:BROADWAY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIA
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:DENOFRIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-574-4779
Mailing Address - Street 1:200 HYPOLUXO RD STE 101-104
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-4532
Mailing Address - Country:US
Mailing Address - Phone:561-246-5555
Mailing Address - Fax:
Practice Address - Street 1:200 HYPOLUXO RD STE 101-104
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-4532
Practice Address - Country:US
Practice Address - Phone:561-246-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care