Healthcare Provider Details

I. General information

NPI: 1053005819
Provider Name (Legal Business Name): BROADWAY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8223 BROADWAY
SAN ANTONIO TX
78209-1919
US

IV. Provider business mailing address

8223 BROADWAY
SAN ANTONIO TX
78209-1919
US

V. Phone/Fax

Practice location:
  • Phone: 210-828-0606
  • Fax: 210-826-7766
Mailing address:
  • Phone: 210-828-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MILLER
Title or Position: MANAGER
Credential:
Phone: 253-268-2410