Provider Demographics
NPI:1629254222
Name:BREAKTHROUGH
Entity Type:Organization
Organization Name:BREAKTHROUGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:H
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTER NURSE,MSN
Authorized Official - Phone:919-493-2791
Mailing Address - Street 1:6 CONSULTANT PL # 100
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3598
Mailing Address - Country:US
Mailing Address - Phone:919-493-2791
Mailing Address - Fax:919-493-4342
Practice Address - Street 1:6 CONSULTANT PL # 100
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3598
Practice Address - Country:US
Practice Address - Phone:919-493-2791
Practice Address - Fax:919-493-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005723Medicaid
NC8301002Medicaid