Provider Demographics
NPI:1003407628
Name:BREAKTHROUGH MED TRANSPORT LLC
Entity Type:Organization
Organization Name:BREAKTHROUGH MED TRANSPORT LLC
Other - Org Name:BREAKTHROUGH TRANSITIONS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-616-1530
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:FL
Mailing Address - Zip Code:32768-0639
Mailing Address - Country:US
Mailing Address - Phone:407-616-1530
Mailing Address - Fax:
Practice Address - Street 1:2110 N DONNELLY ST STE 500
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6968
Practice Address - Country:US
Practice Address - Phone:321-362-4176
Practice Address - Fax:321-256-5176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BREAKTHROUGH TRANSITIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-27
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker