MEDICARE: BREAKTHROUGH RECOVERY GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	32160200	WA

General Provider Information

NPI Number	:	1083053854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAKTHROUGH RECOVERY GROUP, INC.

Provider Business Mailing Address
First Line	:	11711 E SPRAGUE AVE
Second Line	:	SUITE D4
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-6126
Country	:	US
Telephone Number	:	509-927-6838
Fax Number	:	509-927-6845

Provider Business Practice Location Address
First Line	:	11711 E SPRAGUE AVE
Second Line	:	SUITE D4
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-6126
Country	:	US
Telephone Number	:	509-927-6838
Fax Number	:	509-927-6845

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LISA F PARKER
Credential	:	CDP
Telephone Number	:	509-927-6838

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	06/14/2013

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