Healthcare Provider Details

I. General information

NPI: 1700711207
Provider Name (Legal Business Name): BREAKTHROUGH CENTER FOR RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 MUSEUM RD STE 101
CONWAY AR
72032-4752
US

IV. Provider business mailing address

1150 MUSEUM RD STE 101
CONWAY AR
72032-4752
US

V. Phone/Fax

Practice location:
  • Phone: 818-741-2404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SANDOVAL
Title or Position: COO
Credential:
Phone: 818-741-2404