Healthcare Provider Details

I. General information

NPI: 1396325635
Provider Name (Legal Business Name): BROADSTEP ACADEMY-INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8521 SIX FORKS RD STE 300
RALEIGH NC
27615-5294
US

IV. Provider business mailing address

8521 SIX FORKS RD STE 300
RALEIGH NC
27615-5294
US

V. Phone/Fax

Practice location:
  • Phone: 919-726-4096
  • Fax:
Mailing address:
  • Phone: 919-726-4096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: ISABELLE E WILLIAMS
Title or Position: ACCOUNTS RECEIVABLE MANAGER
Credential:
Phone: 919-703-2829