Healthcare Provider Details

I. General information

NPI: 1306655345
Provider Name (Legal Business Name): BREAKING ALL BOUNDARIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3138 N MAIN ST
DAYTON OH
45405-2701
US

IV. Provider business mailing address

4071 MIDDLEHURST LN
DAYTON OH
45406-3429
US

V. Phone/Fax

Practice location:
  • Phone: 937-369-6430
  • Fax:
Mailing address:
  • Phone: 937-369-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAWANA DENISE DRAKES
Title or Position: PARTNER
Credential:
Phone: 937-369-6430