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General NPI Number Information
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NPI Number | 1487462677
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Entity Type | Organization
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Legal Business Name | BREAKING THE CYCLE LLC
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 11101 W CHAPIN AVE
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City | BOISE
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State | ID
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Zip | 83709-6612
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Country | US
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Telephone | 480-299-2385
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Fax |
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Provider Business Mailing Address
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Address Line | 24871 S ELLSWORTH RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-1574
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Country | US
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Telephone | 480-299-2385
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Fax |
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Authorized Official
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Title or Position | VP OF PROGRAM INTEGRITY
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Name | BROOKE SGUARDO
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Credential |
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Telephone | 480-299-2385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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