Provider Demographics
NPI:1760948152
Name:BREAKTHROUGH THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:BREAKTHROUGH THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DERRICK
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:856-288-2232
Mailing Address - Street 1:2 LOGAN SQ STE 300
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-2733
Mailing Address - Country:US
Mailing Address - Phone:856-288-2232
Mailing Address - Fax:
Practice Address - Street 1:1500 MARKET ST. 12TH FLOOR SUITE 75
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:856-288-2232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty