Provider Demographics
NPI:1700923927
Name:BREAKING FREE
Entity Type:Organization
Organization Name:BREAKING FREE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CACCIATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-572-8228
Mailing Address - Street 1:800 W 5TH AVE
Mailing Address - Street 2:SUITE 102 B
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8965
Mailing Address - Country:US
Mailing Address - Phone:630-355-2585
Mailing Address - Fax:630-355-2676
Practice Address - Street 1:800 W 5TH AVE
Practice Address - Street 2:SUITE 102 B
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8965
Practice Address - Country:US
Practice Address - Phone:630-355-2585
Practice Address - Fax:630-355-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-0380-0004-A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0380OtherDASA PROVIDER NUMBER
IL1839OtherBLUE CROSS PROVIDER NUMBE
IL=========003Medicaid