Provider Demographics
NPI:1598898603
Name:BROADSTEP ACADEMY-NEW JERSEY, INC.
Entity Type:Organization
Organization Name:BROADSTEP ACADEMY-NEW JERSEY, INC.
Other - Org Name:WILLOWGLEN ACADEMY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-579-3700
Mailing Address - Street 1:8 WILSON DR.
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871
Mailing Address - Country:US
Mailing Address - Phone:973-579-3700
Mailing Address - Fax:973-579-1786
Practice Address - Street 1:8 WILSON DR.
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3491
Practice Address - Country:US
Practice Address - Phone:973-579-3700
Practice Address - Fax:973-579-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8374104Medicaid
NJ8378304Medicaid
NJ8374503Medicaid
NJ8401403Medicaid