Healthcare Provider Details

I. General information

NPI: 1568789998
Provider Name (Legal Business Name): BROADSTAR INSTALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2010
Last Update Date: 04/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 OLD WARWICK RD
RICHMOND VA
23224-4723
US

IV. Provider business mailing address

4801 OLD WARWICK RD
RICHMOND VA
23224-4723
US

V. Phone/Fax

Practice location:
  • Phone: 866-277-8144
  • Fax: 804-201-8177
Mailing address:
  • Phone: 866-277-8144
  • Fax: 804-201-8177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHNNY CHARLES WILLIAMS IV
Title or Position: CEO
Credential:
Phone: 866-277-8144