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General NPI Number Information
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NPI Number | 1306655345
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Entity Type | Organization
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Legal Business Name | BREAKING ALL BOUNDARIES, LLC
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 3138 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45405-2701
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Country | US
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Telephone | 937-369-6430
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Fax |
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Provider Business Mailing Address
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Address Line | 4071 MIDDLEHURST LN
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City | DAYTON
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State | OH
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Zip | 45406-3429
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Country | US
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Telephone | 937-369-6430
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | TAWANA DENISE DRAKES
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Credential |
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Telephone | 937-369-6430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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