Provider Demographics
NPI:1295872513
Name:BREAKING FREE
Entity type:Organization
Organization Name:BREAKING FREE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STRICKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:630-897-1003
Mailing Address - Street 1:120 GALE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-5084
Mailing Address - Country:US
Mailing Address - Phone:308-971-0036
Mailing Address - Fax:308-971-0426
Practice Address - Street 1:120 GALE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-5084
Practice Address - Country:US
Practice Address - Phone:630-897-1003
Practice Address - Fax:630-572-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-0380-0002-A251S00000X
IL251S00000X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1839OtherBLUE CROSS PROVIDER NUMBE
IL0380OtherDASA PROVIDER NUMBER
IL=========001Medicaid