Provider Demographics
NPI:1053689596
Name:BREAKTHRU, LLC
Entity Type:Organization
Organization Name:BREAKTHRU, LLC
Other - Org Name:MAJESTIC TRANSPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/GENERAL MGR.
Authorized Official - Prefix:
Authorized Official - First Name:OLU
Authorized Official - Middle Name:W
Authorized Official - Last Name:OMODARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-521-5856
Mailing Address - Street 1:14435 W VERDE LN
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8335
Mailing Address - Country:US
Mailing Address - Phone:623-521-5856
Mailing Address - Fax:
Practice Address - Street 1:14435 W VERDE LN
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-8335
Practice Address - Country:US
Practice Address - Phone:623-521-5856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)