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General NPI Number Information
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NPI Number | 1235676248
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Entity Type | Organization
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Legal Business Name | A BROADER FUTURE, INC
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Dates
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Enumeration Date | 01/27/2017
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 3444 BRAGG BLVD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-3946
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Country | US
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Telephone | 910-322-3001
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Fax |
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Provider Business Mailing Address
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Address Line | 882 SOUTHVIEW CIR
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-0318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ANDREA BROADNAX
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Credential |
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Telephone | 910-286-7873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2016-3437-01
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License Number State | NC
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