Provider Demographics
NPI:1538846944
Name:BROKEN TO BLESSED RECOVERY INC
Entity type:Organization
Organization Name:BROKEN TO BLESSED RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, CPDM, MS
Authorized Official - Phone:270-932-1307
Mailing Address - Street 1:1397 CHANEY PIKE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9123
Mailing Address - Country:US
Mailing Address - Phone:270-465-3946
Mailing Address - Fax:
Practice Address - Street 1:1397 CHANEY PIKE
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9123
Practice Address - Country:US
Practice Address - Phone:270-465-3946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility