Provider Demographics
NPI:1982909503
Name:BREAKTHROUGH RECOVERY OUTREACH, LLC
Entity Type:Organization
Organization Name:BREAKTHROUGH RECOVERY OUTREACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-493-7750
Mailing Address - Street 1:3648 CHAMBLEE TUCKER RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4403
Mailing Address - Country:US
Mailing Address - Phone:770-493-7750
Mailing Address - Fax:770-493-5577
Practice Address - Street 1:3648 CHAMBLEE TUCKER RD
Practice Address - Street 2:SUITE F
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4403
Practice Address - Country:US
Practice Address - Phone:770-493-7750
Practice Address - Fax:770-493-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044085D324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility