| Broken Chain Foundation | |
|
4824 Kellywood Dr Glen Allen VA 23060-3643 | |
| (804) 405-3206 | |
| (804) 658-3105 |
| Full Name | Broken Chain Foundation |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4824 Kellywood Dr, Glen Allen, Virginia |
| Authorized Official Name and Position | Eric Christopher Harris (CEO/EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8044053206 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broken Chain Foundation 4824 Kellywood Dr Glen Allen VA 23060-3643 Ph: (804) 405-3206 | Broken Chain Foundation 4824 Kellywood Dr Glen Allen VA 23060-3643 Ph: (804) 405-3206 |
| NPI Number | 1568696904 |
|---|---|
| Provider Enumeration Date | 05/13/2009 |
| Last Update Date | 05/13/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568696904 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 0000000000 (Virginia) | Primary |
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