Organization
BREAK THE CYCLE FOUNDATION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER PENROD (AUTHORIZED REP)
(305) 900-4715
Entity
Organization
Contact information
Practice address
4103 W 26TH ST, CHICAGO, IL 60623-4313
(773) 521-1601
Mailing address
4103 W 26TH ST, CHICAGO, IL 60623-4313
(773) 521-1601
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM2800X
Methadone Clinic
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
06/12/2024
Last updated
06/13/2024
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