OrganizationActive
Broadstep Academy-Illinois Inc
NPI 1104593565 · Mental Illness Community Based Residential Treatment Facility · Marengo, IL
Provider details
- NPI number
- 1104593565
- Entity type
- Organization
- Primary specialty
- Mental Illness Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Kedrian Coleman, Director Revenue Cycle(919) 709-0197
Specialties & taxonomies
Residential Treatment Facilities
Profile Score
Established profile(62/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
4 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
805 Thornapple Ln
Marengo, IL 60152-3414
Phone: (815) 568-5323
Street-level locationGet directions
Mailing address
8521 Six Forks Rd Ste 300
Raleigh, NC 27615-5294
Registry dates
- Enumerated
- 2021-08-24
- Last updated
- 2021-08-25
- Certified
- 2021-08-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.