Provider Demographics
NPI:1285007476
Name:BREAK-THROUGH RECOVERY SERVICES, LLC
Entity Type:Organization
Organization Name:BREAK-THROUGH RECOVERY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMSW
Authorized Official - Phone:313-570-9555
Mailing Address - Street 1:30578 SOUTHFIELD RD APT 252
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1225
Mailing Address - Country:US
Mailing Address - Phone:313-570-9555
Mailing Address - Fax:
Practice Address - Street 1:30578 SOUTHFIELD RD APT 252
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1225
Practice Address - Country:US
Practice Address - Phone:313-570-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health