Healthcare Provider Details

I. General information

NPI: 1275003998
Provider Name (Legal Business Name): BREAKING CHAINS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 E 25TH ST
BALTIMORE MD
21218-5512
US

IV. Provider business mailing address

4103 OAKFORD AVE
BALTIMORE MD
21215-4943
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-6557
  • Fax:
Mailing address:
  • Phone: 410-800-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KARIMA CARRINGTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-800-6557