BROADWAY HOUSE, INC. (NPI# 1710106778) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710106778 |
| Entity Type | Organization |
| Organization Name | BROADWAY HOUSE, INC. |
| Practice Address |
221 2nd Ave Nw Ardmore OK 73401-6202 |
| Practice Telephone | 5802263252 |
| Practice Fax Number | 5802263849 |
| Mailing Telephone | 5802263252 |
| Mailing Fax Number | 5802263849 |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. WADONNA D WELLS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 5802263252 |
| Authorized Official Credential | MHR, LADC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Street Address |
221 2ND AVE NW |
| City | ARDMORE |
| State | OK |
| Zip Code | 73401-6202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376836957 | Jimmy A Jackson | Counselor | 221 2nd Ave Nw, Ardmore, OK 73401-6202 | 2011-05-16 |
| 1801022181 | Wadonna Wells | Counselor | 221 2nd Ave Nw, Ardmore, OK 73401-6202 | 2009-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497391452 | Abbie Deeann Mclemore | Nurse Practitioner | 915 10th Ave, Ardmore, OK 73401 | 2019-11-25 |
| 1790349991 | Shirley Denise Brown | Licensed Psychiatric Technician | 1219 Kst N.w, 1219 Kst N.w, Ardmore, OK 73401 | 2019-04-24 |
| 1427512359 | Billy Joe Oshields | Case Manager/Care Coordinator | 6862 State Hwy 199 Ardmore Oklahoma, 6862 State Hwy 199, Ardmore, OK 73401 | 2019-01-24 |
| 1174007595 | Tawnya Dawn Peery | Nurse Practitioner | 1108 W. Walnut Drive, Ardmore, OK 73401 | 2018-09-21 |
| 1679055016 | Teresa Marie Hernandez | Behavior Technician | 1219 K St. Nw, Ardmore, OK 73401 | 2018-09-01 |
| 1063991974 | Sawyer Rae Shamburger | Occupational Therapy Assistant | 208 North Praire St, Pilot Point, TX 73401 | 2018-08-10 |
| 1417473521 | Chelsye Bacon | Peer Specialist | 905 Holiday Drive, Ardmore, OK 73401 | 2017-08-21 |
| 1003279746 | Jeni Presley | Marriage & Family Therapist | Outpatient Services-ardmore; 2510 Chickasaw Dr., Strong Family Development;, Ardmore, OK 73401 | 2016-03-31 |
| 1982080909 | Alison Hill | Pharmacist | 1111 N. Commerce, Ardmore, OK 73401 | 2015-07-31 |
| 1316346547 | Olivia Larae Carrell | Counselor | 15 Monroe Street Ne, Ardmore, OK 73401 | 2014-08-13 |
| Find all providers in zip 73401 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194889022 | Womanspace Ardmore | Substance Abuse Rehabilitation Facility | 120 Ardmore Ave, Ardmore, PA 19003-1315 | 2006-12-22 |
| 1083923213 | Martin Maytubby Sr. | Substance Abuse Rehabilitation Facility | 9 10th Ave Nw, Ardmore, OK 73401-5929 | 2010-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790301893 | Second Chance Recovery Center, Inc. | Substance Abuse Rehabilitation Facility | 4238 Ne 1st St, Pryor, OK 74361-9614 | 2020-06-24 |
| 1912551805 | Estelle Hawkins | Substance Abuse Rehabilitation Facility | 21227 N County Road 3350, Wynnewood, OK 73098-9356 | 2019-07-29 |
| 1902359391 | Ryan Fitzpatrick | Substance Abuse Rehabilitation Facility | 7138 S Canton Ave, Tulsa, OK 74136-6303 | 2016-08-02 |
| 1609223866 | Seven Ponds Energy LLC Dba Seven Ponds Residential Treatment | Substance Abuse Rehabilitation Facility | 1760 Blevins Rd., Bennington, OK 74723 | 2016-05-18 |
| 1679938534 | Claudia Antoinette Parker | Substance Abuse Rehabilitation Facility | 301 Pointe Parkway Blvd Apt 706, Yukon, OK 73099-0641 | 2015-12-20 |
| 1184089328 | Door 2 Ur Future | Substance Abuse Rehabilitation Facility | 1050 E 61st St Apt 89, Tulsa, OK 74136-1397 | 2015-12-15 |
| 1144627233 | Denise Evyonne Engram | Substance Abuse Rehabilitation Facility | 4723 S Ash Dr, Broken Arrow, OK 74011-3464 | 2014-12-04 |
| 1093127979 | Kimberly Ann Kelly-lorenz | Substance Abuse Rehabilitation Facility | 163 Mohawk Dr, Canadian, OK 74425-9747 | 2014-05-27 |
| 1558783589 | Vizown LLC | Substance Abuse Rehabilitation Facility | 24962 Okay Rd, Tecumseh, OK 74873-6504 | 2014-01-10 |
| 1104256684 | Robert Watson | Substance Abuse Rehabilitation Facility | 111 W 5th St Ste 600, Tulsa, OK 74103-4260 | 2013-11-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.