Provider Demographics
NPI:1386035079
Name:BREAKTHRU AUTISM SERVICES
Entity Type:Organization
Organization Name:BREAKTHRU AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFINI
Authorized Official - Middle Name:RUSHANNE
Authorized Official - Last Name:CHAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-232-3691
Mailing Address - Street 1:9653 MARLETTE DR
Mailing Address - Street 2:
Mailing Address - City:NOKESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20181-3001
Mailing Address - Country:US
Mailing Address - Phone:571-232-3691
Mailing Address - Fax:703-794-7359
Practice Address - Street 1:9653 MARLETTE DR
Practice Address - Street 2:
Practice Address - City:NOKESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20181-3001
Practice Address - Country:US
Practice Address - Phone:571-232-3691
Practice Address - Fax:703-794-7359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health