Provider Demographics
NPI:1205446044
Name:BREAKTHROUGH
Entity type:Organization
Organization Name:BREAKTHROUGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUKIMO
Authorized Official - Middle Name:D
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:612-201-8111
Mailing Address - Street 1:2147 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1313
Mailing Address - Country:US
Mailing Address - Phone:651-340-6795
Mailing Address - Fax:651-202-3166
Practice Address - Street 1:2147 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1313
Practice Address - Country:US
Practice Address - Phone:651-340-6795
Practice Address - Fax:651-202-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder