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General NPI Number Information
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NPI Number | 1295240265
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Entity Type | Organization
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Legal Business Name | BREAKING BARRIERS LLC
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 14500 BURNHAVEN DR STE 123
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City | BURNSVILLE
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State | MN
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Zip | 55306-4926
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Country | US
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Telephone | 952-303-3489
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Fax |
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Provider Business Mailing Address
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Address Line | 14500 BURNHAVEN DR STE 123
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City | BURNSVILLE
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State | MN
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Zip | 55306-4926
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Country | US
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Telephone | 952-303-3489
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF SERVICES
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Name | KELLY MICHAEL WELSH
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Credential |
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Telephone | 952-303-3489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | MN
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