| Broadscope LLC | |
|
12139 Mount Vernon Ave Ste 101 Grand Terrace CA 92313-5519 | |
| (951) 440-2730 | |
| Not Available |
| Full Name | Broadscope LLC |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 12139 Mount Vernon Ave Ste 101, Grand Terrace, California |
| Authorized Official Name and Position | Meelynda Rayford (COO) |
| Authorized Official Contact | 9514402730 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadscope LLC 12139 Mount Vernon Ave Ste 101 Grand Terrace CA 92313-5519 | Broadscope LLC 12139 Mount Vernon Ave Ste 101 Grand Terrace CA 92313-5519 Ph: (951) 440-2730 |
| NPI Number | 1922251404 |
|---|---|
| Provider Enumeration Date | 10/29/2008 |
| Last Update Date | 10/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922251404 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (NU) | Primary |
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