NPIMap

Organization Active NPI

Breaking Free, LLC

  • Community/Behavioral Health Agency
  • Lebanon, OR
National Provider Identifier
1629575212
Registry record updated Mar 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
BREAKING FREE, LLC
Practice address
165 S Main St
Lebanon, OR 97355-4223
Phone
(541) 405-4622
Fax
(541) 405-4381
NPI assigned
Apr 10, 2018
Last updated
Mar 26, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2020

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

Authorized official

Name
Ms. Tammy Renea Kromhout
Title
Co-Owner
Phone
(541) 405-4622

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

165 S Main St
Lebanon, OR 97355-4223

Mailing address

PO Box 24
Jefferson, OR 97352-0024
Phone (541) 327-8099

Other identifiers 1

IdentifierTypeStateIssuer
500717667MedicaidOR

National Provider Directory

National Provider Directory

Locations

115 S 2nd St
Jefferson, OR 97352

165 S Main St
Lebanon, OR 97355
Phone (541) 405-4622

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585180800000",
    "number": "1629575212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24",
            "city": "JEFFERSON",
            "state": "OR",
            "postal_code": "973520024",
            "telephone_number": "541-327-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 S MAIN ST",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973554223",
            "telephone_number": "541-405-4622",
            "fax_number": "541-405-4381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKING FREE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-10",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A",
        "authorized_official_last_name": "KROMHOUT",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "RENEA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "541-405-4622",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500717667",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; 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.