Provider Demographics
NPI:1962780932
Name:BROADENED HORIZONS INC.
Entity type:Organization
Organization Name:BROADENED HORIZONS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:FELLING
Authorized Official - Suffix:
Authorized Official - Credentials:EE, MBA
Authorized Official - Phone:612-851-1040
Mailing Address - Street 1:9025 BURTON CT NW
Mailing Address - Street 2:OFFICE SUITE
Mailing Address - City:RICE
Mailing Address - State:MN
Mailing Address - Zip Code:56367-6602
Mailing Address - Country:US
Mailing Address - Phone:612-851-1040
Mailing Address - Fax:866-672-8919
Practice Address - Street 1:9025 BURTON CT NW
Practice Address - Street 2:OFFICE SUITE
Practice Address - City:RICE
Practice Address - State:MN
Practice Address - Zip Code:56367-6602
Practice Address - Country:US
Practice Address - Phone:612-851-1040
Practice Address - Fax:866-672-8919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier