Provider Demographics
NPI:1821707860
Name:BREAKTHROUGH COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:BREAKTHROUGH COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DSP
Authorized Official - Prefix:
Authorized Official - First Name:COLISHA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:VANPELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-881-6034
Mailing Address - Street 1:1990 SPICETREE LN SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-3406
Mailing Address - Country:US
Mailing Address - Phone:503-881-6034
Mailing Address - Fax:
Practice Address - Street 1:1990 SPICETREE LN SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-3406
Practice Address - Country:US
Practice Address - Phone:503-881-6034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health