Provider Demographics
NPI:1376200428
Name:BREAKTHROUGH COMMUNITY DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:BREAKTHROUGH COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAWANYA
Authorized Official - Middle Name:T
Authorized Official - Last Name:JERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-221-7447
Mailing Address - Street 1:1831 FOREST DR STE G
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4430
Mailing Address - Country:US
Mailing Address - Phone:443-221-7447
Mailing Address - Fax:
Practice Address - Street 1:1831 FOREST DR STE G
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4430
Practice Address - Country:US
Practice Address - Phone:443-221-7447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health