Provider Demographics
NPI:1992820757
Name:MAYWOOD MELROSE BROADVIEW 89
Entity type:Organization
Organization Name:MAYWOOD MELROSE BROADVIEW 89
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-450-2157
Mailing Address - Street 1:1133 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-1903
Mailing Address - Country:US
Mailing Address - Phone:708-450-2157
Mailing Address - Fax:708-450-1116
Practice Address - Street 1:1133 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-1903
Practice Address - Country:US
Practice Address - Phone:708-450-2157
Practice Address - Fax:708-450-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health