Healthcare Provider Details

I. General information

NPI: 1245461581
Provider Name (Legal Business Name): BREAKING BOUNDARIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84-1170 FARRINGTON HWY A2-BFA
WAIANAE HI
96792-2060
US

IV. Provider business mailing address

338 KAMOKILA BLVD. SUITE 206
KAPOLEI HI
96707
US

V. Phone/Fax

Practice location:
  • Phone: 808-695-0444
  • Fax: 808-695-0555
Mailing address:
  • Phone: 808-312-1530
  • Fax: 808-744-6793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. WANDA M CURRY
Title or Position: PRESIDENT/CEO
Credential: CSAC
Phone: 808-265-0713