Healthcare Provider Details

I. General information

NPI: 1164200465
Provider Name (Legal Business Name): BREEZE MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 03/24/2024
Certification Date: 03/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5626 FRANTZ RD
DUBLIN OH
43017-1559
US

IV. Provider business mailing address

305 LINDEN ST FL 4
SCRANTON PA
18503-1430
US

V. Phone/Fax

Practice location:
  • Phone: 570-539-7234
  • Fax: 570-302-4238
Mailing address:
  • Phone: 740-422-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. SARAH RED
Title or Position: OWNER
Credential: APRN
Phone: 570-539-7234