Provider Demographics
NPI:1033594916
Name:BREAKTHROUGH DEVELOPMENTAL SERVICES, LLC
Entity Type:Organization
Organization Name:BREAKTHROUGH DEVELOPMENTAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERBY-YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-255-5270
Mailing Address - Street 1:5416 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3444
Mailing Address - Country:US
Mailing Address - Phone:855-255-5270
Mailing Address - Fax:855-513-1069
Practice Address - Street 1:5416 16TH AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3444
Practice Address - Country:US
Practice Address - Phone:855-255-5270
Practice Address - Fax:855-513-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA076251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1338048-00Medicaid