| Breaking Free Inc | |
|
120 Gale St Aurora IL 60506-5084 | |
| (630) 897-1003 | |
| (630) 897-1042 |
| Full Name | Breaking Free Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 120 Gale St, Aurora, Illinois |
| Authorized Official Name and Position | Dimitrius R Mayo (MANAGER, REVENUE CYCLE) |
| Authorized Official Contact | 6305720556 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Breaking Free Inc 120 Gale St Aurora IL 60506-5084 Ph: (630) 897-1003 | Breaking Free Inc 120 Gale St Aurora IL 60506-5084 Ph: (630) 897-1003 |
| NPI Number | 1649703018 |
|---|---|
| Provider Enumeration Date | 04/04/2017 |
| Last Update Date | 04/04/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649703018 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | A-0380-0002-A (Illinois) | Primary |
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