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General NPI Number Information
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NPI Number | 1003248378
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Entity Type | Organization
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Legal Business Name | BREAK4HEALTH
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Dates
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Enumeration Date | 08/08/2013
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 1535 LAKE COOK RD #112
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City | NORTHBROOK
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State | IL
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Zip | 60062-1447
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Country | US
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Telephone | 224-235-4758
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Fax |
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Provider Business Mailing Address
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Address Line | 401 HUEHL RD 2A
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City | NORTHBROOK
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State | IL
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Zip | 60062-2300
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Country | US
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Telephone | 847-513-7905
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | JENNIFER L MANDELL
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Credential |
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Telephone | 847-309-7698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 2137912
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License Number State | IL
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