Healthcare Provider Details

I. General information

NPI: 1487462677
Provider Name (Legal Business Name): BREAKING THE CYCLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 W CHAPIN AVE
BOISE ID
83709-6612
US

IV. Provider business mailing address

7950 W KING ST
BOISE ID
83704-7157
US

V. Phone/Fax

Practice location:
  • Phone: 480-299-2385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MALLORY HARRIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 605-496-5067