Healthcare Provider Details

I. General information

NPI: 1922089002
Provider Name (Legal Business Name): BROADLAWNS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date: 11/09/2007
Reactivation Date: 04/03/2008

III. Provider practice location address

1801 HICKMAN ROAD
DES MOINES IA
50314
US

IV. Provider business mailing address

1801 HICKMAN ROAD
DES MOINES IA
50314
US

V. Phone/Fax

Practice location:
  • Phone: 515-282-2200
  • Fax: 515-282-3234
Mailing address:
  • Phone: 515-282-2200
  • Fax: 515-282-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: JODY J JENNER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 515-282-2234