Provider Demographics
NPI:1710614367
Name:BRING YOUR BROKENNESS INC
Entity Type:Organization
Organization Name:BRING YOUR BROKENNESS INC
Other - Org Name:BRING YOUR BROKENNESS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-789-4673
Mailing Address - Street 1:87616 ROSES BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-4998
Mailing Address - Country:US
Mailing Address - Phone:904-789-4673
Mailing Address - Fax:
Practice Address - Street 1:87616 ROSES BLUFF RD
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-4998
Practice Address - Country:US
Practice Address - Phone:904-789-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8742OtherAHCA LICENSE