Provider Demographics
NPI:1376866160
Name:BREAKTHROUGH BELIEVERS RECOVERY AND HEALING CENTER
Entity Type:Organization
Organization Name:BREAKTHROUGH BELIEVERS RECOVERY AND HEALING CENTER
Other - Org Name:BEHAVIORAL HEALTH SERVICES, REHAB, HEALTHCARE PROVIDER, COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUVALL-BATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ABA, MAJOR SOCIOLOGY
Authorized Official - Phone:616-272-3796
Mailing Address - Street 1:349 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-1114
Mailing Address - Country:US
Mailing Address - Phone:231-343-2753
Mailing Address - Fax:
Practice Address - Street 1:924 EASTERN AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-1303
Practice Address - Country:US
Practice Address - Phone:231-343-2753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI410357101YA0400X, 103TP2701X, 1041C0700X, 171M00000X, 251S00000X, 251X00000X, 252Y00000X, 305R00000X, 305S00000X, 310400000X
MI610081251B00000X, 253Z00000X, 347C00000X
MISA410357251S00000X
MISA0410357343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376866160OtherSUBPART HEALTHCARE PROVIDER LICENSE: 410357, 610081, 700099, 110106
MI1376866160Medicaid
MI1376866160Medicare Oscar/Certification