Provider Demographics
NPI:1316298045
Name:BROADVIEW HEALTH, PA
Entity type:Organization
Organization Name:BROADVIEW HEALTH, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TREASURE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:704-544-0050
Mailing Address - Street 1:349 VENUS ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4025
Mailing Address - Country:US
Mailing Address - Phone:704-635-7418
Mailing Address - Fax:704-635-7500
Practice Address - Street 1:17232 LANCASTER HWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2002
Practice Address - Country:US
Practice Address - Phone:704-544-0050
Practice Address - Fax:704-544-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00832261QM0801X
363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921569Medicaid
NC1083043913Medicaid