| A Broad Place Llc | |
|
3608 Milford Mill Rd Windsor Mill MD 21244-3328 | |
| (443) 272-7858 | |
| (443) 405-7137 |
| Full Name | A Broad Place Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 3608 Milford Mill Rd, Windsor Mill, Maryland |
| Authorized Official Name and Position | Abimbola Runsewe (CLINICAL DIRECTOR) |
| Authorized Official Contact | 4432727858 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| A Broad Place Llc 3608 Milford Mill Rd Windsor Mill MD 21244-3328 Ph: (443) 272-7858 | A Broad Place Llc 3608 Milford Mill Rd Windsor Mill MD 21244-3328 Ph: (443) 272-7858 |
| NPI Number | 1669190450 |
|---|---|
| Provider Enumeration Date | 08/17/2022 |
| Last Update Date | 08/17/2022 |
| Certification Date | 08/17/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669190450 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
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