MEDICARE: BROADVIEW, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282J00000X	Religious Nonmedical Health Care Institution	051991	CA

General Provider Information

NPI Number	:	1417950445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADVIEW, INC.

Provider Business Mailing Address
First Line	:	4570 GRIFFIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-1422
Country	:	US
Telephone Number	:	323-221-9174
Fax Number	:	323-221-7194

Provider Business Practice Location Address
First Line	:	4570 GRIFFIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-1422
Country	:	US
Telephone Number	:	323-221-9174
Fax Number	:	323-221-7194

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MR. MARK P ZUNDEL-WATERSON
Credential	:
Telephone Number	:	323-221-9174

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/22/2020

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