MEDICARE: BREAKING CHAINS INC

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	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1275003998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAKING CHAINS INC

Provider Business Mailing Address
First Line	:	4103 OAKFORD AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-4943
Country	:	US
Telephone Number	:	410-800-6557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 E 25TH ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-5512
Country	:	US
Telephone Number	:	410-800-6557
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KARIMA CARRINGTON
Credential	:
Telephone Number	:	410-800-6557

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	08/30/2019

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Directions to “BREAKING CHAINS INC ” Practice Location

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