Provider Demographics
NPI:1205289287
Name:BREEZE RECOVERY LLC
Entity type:Organization
Organization Name:BREEZE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:AKERET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCADC
Authorized Official - Phone:609-675-6907
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-0123
Mailing Address - Country:US
Mailing Address - Phone:609-675-6907
Mailing Address - Fax:844-657-9591
Practice Address - Street 1:359 96TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:STONE HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08247-1409
Practice Address - Country:US
Practice Address - Phone:609-675-6907
Practice Address - Fax:844-657-9591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052792001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
532115Medicare PIN