Healthcare Provider Details

I. General information

NPI: 1407271554
Provider Name (Legal Business Name): BREAKING BOUNDARIES RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84-1170 FARRINGTON HWY
WAIANAE HI
96792-2060
US

IV. Provider business mailing address

338 KAMOKILA BLVD SUITE 206
KAPOLEI HI
96707-2055
US

V. Phone/Fax

Practice location:
  • Phone: 808-312-1530
  • Fax:
Mailing address:
  • Phone: 808-312-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: WANDA CURRY
Title or Position: PRES. & CEO
Credential:
Phone: 808-312-1530