Provider Demographics
NPI:1578173050
Name:BREAKING BARRIERS INSITITUTE LLC
Entity Type:Organization
Organization Name:BREAKING BARRIERS INSITITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:310-388-7365
Mailing Address - Street 1:9920 19TH ST APT 59
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-4268
Mailing Address - Country:US
Mailing Address - Phone:310-388-7365
Mailing Address - Fax:909-912-8484
Practice Address - Street 1:9920 19TH ST APT 59
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-4268
Practice Address - Country:US
Practice Address - Phone:310-388-7365
Practice Address - Fax:909-912-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty