Provider Demographics
NPI:1306017165
Name:BREAKTHROUGH SERVICES INC.
Entity Type:Organization
Organization Name:BREAKTHROUGH SERVICES INC.
Other - Org Name:BREAKTHROUGH HOMES AND SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FISCAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:BODNARIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-347-6009
Mailing Address - Street 1:114A MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6328
Mailing Address - Country:US
Mailing Address - Phone:910-347-6009
Mailing Address - Fax:910-355-2267
Practice Address - Street 1:114A MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6328
Practice Address - Country:US
Practice Address - Phone:910-347-6009
Practice Address - Fax:910-355-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418095Medicaid
NC8301307Medicaid
NC8301307BMedicaid
NC8301307GMedicaid