Provider Demographics
NPI:1780029264
Name:BREAKING THE LINKS
Entity Type:Organization
Organization Name:BREAKING THE LINKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAPLAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:O'REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-745-7389
Mailing Address - Street 1:630 SCHULTZ ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345
Mailing Address - Country:US
Mailing Address - Phone:616-745-7389
Mailing Address - Fax:
Practice Address - Street 1:630 SCHULTZ ST
Practice Address - Street 2:SPARTA, MI
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-9426
Practice Address - Country:US
Practice Address - Phone:616-745-7389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty