Organization
BREAKAWAY IOP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRADY BRAXTON JEFFERYS JR. PH.D. (PROGRAM DIRECTOR)
(828) 273-1643
Entity
Organization
Contact information
Practice address
7 BEAVERDAM RD, ASHEVILLE, NC 28804-6626
(828) 707-0250
Mailing address
213 MEADOW RUN EXT, ASHEVILLE, NC 28806-9787
(828) 707-0250
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
06/20/2015
Last updated
06/20/2015
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