Broken Pieces Services LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

BROKEN PIECES SERVICES LLC

Practice address

2020 Remount Rd
Gastonia, NC 28054-7476

Phone

(980) 355-3737

NPI assigned

Aug 22, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Marquita RussellNPI 1376323667

Title

Operations

Phone

(980) 258-9315

Specialties & licenses 12

Addresses

Other identifiers 2

Electronic endpoints 3

Tax ID family

Broken Pieces Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Broken Pieces Services LLC

  • Community/Behavioral Health Agency
  • Gastonia, NC
  • NPI 1093245417
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marquita Russell, LCSW-A

  • Clinical Social Worker
  • Gastonia, NC
  • NPI 1376323667
  NPD Authorized official
• Malivan D. Xaiyakosy

  • Clinical Social Worker
  • Gastonia, NC
  • NPI 1144058975
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692057600000",
    "number": "1265959100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 REMOUNT RD STE G-100B",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280547476",
            "telephone_number": "980-355-3737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 REMOUNT RD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280547476",
            "telephone_number": "980-355-3737"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "706 Lazy Oak Ct",
            "address_purpose": "LOCATION",
            "city": "Clover",
            "state": "SC",
            "postal_code": "297107848",
            "country_code": "US",
            "telephone_number": "980-258-9315",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8021 Bella Vista Ct",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282162043",
            "country_code": "US",
            "telephone_number": "980-258-9315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BROKEN PIECES SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-22",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "MARQUITA",
        "authorized_official_title_or_position": "OPERATIONS",
        "authorized_official_telephone_number": "980-258-9315",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2055X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Mental Illness, Child",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2065X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Physical Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00571688",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP7951",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mn@brokenpiecesllc.org.in",
            "affiliation": "N",
            "address_1": "2020 Remount Rd # W114",
            "city": "Gastonia",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280547476",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mn@brokenpiecesllc.org.in",
            "affiliation": "N",
            "endpointDescription": "mn@brokenpiecesllc.org.in",
            "address_1": "2020 Remount Rd Ste G100-B",
            "city": "Gastonia",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280547476",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "mn@brokenpiecesllc.org.in",
            "affiliation": "N",
            "address_1": "2020 Remount Rd Ste G100-B",
            "city": "Gastonia",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280547476",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Courtney Nicole Broderick, MS, CCC-SLP
• John Anthony Brodston, M.D.
• Abigail Carter Brody, MA, LCMHC
• Charity Brogdon, LCSWA
• Broken Pieces Services LLC
• Teena Lavette Brooks, LCMHC, BC-TMH
• Catherine S Broome, CRNA
• Kathleen L Broome, RDH
• Aaron Daniel Brown, MD
• Alexis Brown, M.S., CCC-SLP

• Community/Behavioral Health Agency in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.