Provider Demographics
NPI:1477919405
Name:BREAKING FREE INC.
Entity Type:Organization
Organization Name:BREAKING FREE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, REVENUE CYCLE
Authorized Official - Prefix:MR
Authorized Official - First Name:DIMITRIUS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-572-0556
Mailing Address - Street 1:120 GALE STREET
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-5084
Mailing Address - Country:US
Mailing Address - Phone:630-897-1003
Mailing Address - Fax:630-897-1042
Practice Address - Street 1:120 GALE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-5084
Practice Address - Country:US
Practice Address - Phone:630-897-1003
Practice Address - Fax:630-897-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health