MEDICARE: BREEZE RECOVERY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05279200	NJ

General Provider Information

NPI Number	:	1205289287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREEZE RECOVERY LLC

Provider Business Mailing Address
First Line	:	PO BOX 123
Second Line	:
City	:	CAPE MAY COURT HOUSE
State	:	NJ
Zip	:	08210-0123
Country	:	US
Telephone Number	:	609-675-6907
Fax Number	:	844-657-9591

Provider Business Practice Location Address
First Line	:	359 96TH ST
Second Line	:	SUITE 302
City	:	STONE HARBOR
State	:	NJ
Zip	:	08247-1409
Country	:	US
Telephone Number	:	609-675-6907
Fax Number	:	844-657-9591

Authorized Official
Title or Position	:	OWNER
Name	:	DIANA L AKERET
Credential	:	LCSW, LCADC
Telephone Number	:	609-675-6907

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	04/19/2017

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