Provider Demographics
NPI:1609077429
Name:BROAD REACH OF CHATHAM INC.
Entity Type:Organization
Organization Name:BROAD REACH OF CHATHAM INC.
Other - Org Name:BROAD REACH OUTPATIENT REHAB.-SLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGDANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:CNHA
Authorized Official - Phone:508-945-4611
Mailing Address - Street 1:390 ORLEANS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02650-1154
Mailing Address - Country:US
Mailing Address - Phone:508-945-4611
Mailing Address - Fax:508-945-2245
Practice Address - Street 1:390 ORLEANS RD
Practice Address - Street 2:
Practice Address - City:NORTH CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02650-1154
Practice Address - Country:US
Practice Address - Phone:508-945-4611
Practice Address - Fax:508-945-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty