MEDICARE: BROADLAWNS MEDICAL CENTER

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	320800000X	Mental Illness Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427133966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADLAWNS MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1812 OAKLAND AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50314-3329
Country	:	US
Telephone Number	:	515-244-8381
Fax Number	:	515-244-1201

Provider Business Practice Location Address
First Line	:	1812 OAKLAND AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50314-3329
Country	:	US
Telephone Number	:	515-244-8381
Fax Number	:	515-244-1201

Authorized Official
Title or Position	:	ACCOUNTANT
Name	:	MRS. JANETTE BORMANN
Credential	:
Telephone Number	:	515-282-6904

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/22/2020

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Directions to “BROADLAWNS MEDICAL CENTER ” Practice Location

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