Organization
BREAK OUT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARNELLA LORRAINE WARTHEN (OWNER/EXECUTIVE DIRECTOR)
(919) 477-4785
Entity
Organization
Contact information
Practice address
412 PINELAND AVE, DURHAM, NC 27704-2911
(919) 220-2181
Mailing address
406 MARE CT, BAHAMA, NC 27503-9615
(919) 477-4785
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
032414
NC
Other
Enumeration date
10/03/2007
Last updated
10/03/2007
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