Provider Demographics
NPI:1417950445
Name:BROADVIEW, INC.
Entity Type:Organization
Organization Name:BROADVIEW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZUNDEL-WATERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-221-9174
Mailing Address - Street 1:4570 GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-1422
Mailing Address - Country:US
Mailing Address - Phone:323-221-9174
Mailing Address - Fax:323-221-7194
Practice Address - Street 1:4570 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-1422
Practice Address - Country:US
Practice Address - Phone:323-221-9174
Practice Address - Fax:323-221-7194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA051991282J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051991Medicare ID - Type Unspecified