| NPI | 1699109546 |
|---|---|
| Doing Business As | BROADWAY YOUTH CENTER |
| Entity Type | Organization |
| Authorized Contact | BURGUNDY JOHNSON Credentialing 872-629-3491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2022-06-27 |