Provider Demographics
NPI:1205163235
Name:BREAK OF DAY MENTAL HEALTH GROUP INC
Entity type:Organization
Organization Name:BREAK OF DAY MENTAL HEALTH GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENLEAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-882-6594
Mailing Address - Street 1:82 GREENLEAF RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04578-3218
Mailing Address - Country:US
Mailing Address - Phone:207-882-6594
Mailing Address - Fax:207-882-6599
Practice Address - Street 1:82 GREENLEAF RD
Practice Address - Street 2:
Practice Address - City:WESTPORT ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04578-3218
Practice Address - Country:US
Practice Address - Phone:207-882-6594
Practice Address - Fax:207-882-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME590802251B00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management