Rusty Broderick in Skyforest - Addiction (substance Use Disorder)
Rusty Broderick - NPI 1346430014
Rusty Broderick is a Addiction (substance Use Disorder) in Skyforest, California. Rusty Broderick practices all healthcare services and medical treatments related to Addiction (substance Use Disorder). The NPI Number for Rusty Broderick is 1346430014. The last update date is 2007-07-30.
Rusty Broderick's current location address is 28545 Highway 18, Skyforest, California. You can contact this provider via phone number 9093361800. The mailing address for Rusty Broderick is 28545 Highway 18, Skyforest, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Rusty Broderick |
|---|---|
| Address | 28545 Highway 18, Skyforest, California |
| Phone Number | 9093361800 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1346430014 |
|---|---|
| Provider Enumeration Date | 2007-07-30 |
| Last Updated Date | 2007-07-30 |
Provider Mailing Address Detail
| Address | 28545 Highway 18 |
|---|---|
| City | Skyforest |
| State | California (CA) |
| Post Code | 923850578 |
| Phone Number | 9093361800 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Addiction (substance Use Disorder) |
|---|---|
| Taxonomy | 101Ya0400X |
| Licence No | RI-B05081810 |
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Definition: A counselor who helps people with alcohol, drug, gambling, internet, and other types of addictions. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 3595 | CA | SIMON |
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What is the unique identifier code issued to Rusty Broderick by the Centers for Medicare & Medicaid Services (CMS)?
The Rusty Broderick has been assigned the NPI (National Provider Identifier) 1346430014. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Can you provide the Rusty Broderick's physical address?
The Rusty Broderick is physically located at 28545 Highway 18, in the city of Skyforest, CA, with the postal code 923850578.
What is the Rusty Broderick's specialty and taxonomy code?
The Rusty Broderick's specialty is Addiction (substance Use Disorder), and the corresponding taxonomy code is 101Ya0400X.
When did the Rusty Broderick receive its 1346430014?
The Rusty Broderick was issued its 1346430014 on 2007-07-30, which is the date when the organization was assigned this unique identifier.
When was the Rusty Broderick's information last updated?
The Rusty Broderick's information was last updated on 2007-07-30.
NPI Number: 1063415297
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