Provider Demographics
NPI:1790413342
Name:BREAKTHROUGH RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:BREAKTHROUGH RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PERLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-671-0763
Mailing Address - Street 1:6191 W ATLANTIC BLVD STE 1&7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5196
Mailing Address - Country:US
Mailing Address - Phone:954-671-0763
Mailing Address - Fax:954-671-0763
Practice Address - Street 1:6191 W ATLANTIC BLVD STE 1&7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5196
Practice Address - Country:US
Practice Address - Phone:954-671-0763
Practice Address - Fax:954-671-0763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility