Bring Your Brokenness Inc

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

Legal business name

BRING YOUR BROKENNESS INC

Doing business as

Bring Your Brokenness Inc
The Charis House

Practice address

87616 Roses Bluff Rd
Yulee, FL 32097-4998

Phone

(904) 789-4673

NPI assigned

Aug 3, 2022

Last updated

Jan 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Amie N. Shields

Title

Ceo

Phone

(904) 789-4673

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• Bring Your Brokenness Inc Doing business as
• The Charis House Doing business as

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

{
    "created_epoch": "1659484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1710614367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87616 ROSES BLUFF RD",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "320974998",
            "telephone_number": "904-789-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87616 ROSES BLUFF RD",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "320974998",
            "telephone_number": "904-789-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRING YOUR BROKENNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-03",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "SHIELDS",
        "authorized_official_first_name": "AMIE",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-789-4673",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA LICENSE",
            "identifier": "8742",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bring Your Brokenness Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Charis House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mark Nicholas Brinkman, D.O.
• Lori M Brodie, PMHNP-BC
• Burgundy Brown
• Larry Brown, LMT
• Lisa Marie Brown

• Psychiatric Residential Treatment Facility in Yulee, FL
• Providers in Yulee, FL by specialty
• Psychiatric Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; 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.