Provider Demographics
NPI:1770224560
Name:BREAKTHROUGH BEHAVIOR SERVICES LLC
Entity Type:Organization
Organization Name:BREAKTHROUGH BEHAVIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:TIBBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:732-853-6969
Mailing Address - Street 1:PO BOX 6853
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-0853
Mailing Address - Country:US
Mailing Address - Phone:732-853-6969
Mailing Address - Fax:
Practice Address - Street 1:537 WAHNETAH DR
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1704
Practice Address - Country:US
Practice Address - Phone:732-853-6969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities