Provider Demographics
NPI:1609951144
Name:BROADLAWNS MEDICAL CENTER
Entity Type:Organization
Organization Name:BROADLAWNS MEDICAL CENTER
Other - Org Name:BROADLAWNS MEDICAL CENTER RESIDENTIAL FACILITIES
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BORMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-282-6904
Mailing Address - Street 1:1812 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1812 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3329
Practice Address - Country:US
Practice Address - Phone:515-244-8381
Practice Address - Fax:515-244-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0236489Medicaid