Healthcare Provider Details

I. General information

NPI: 1457723439
Provider Name (Legal Business Name): BREAKTHROUGH HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S SCHUYLER AVE STE 265
KANKAKEE IL
60901-5102
US

IV. Provider business mailing address

555 S SCHUYLER AVE STE 265
KANKAKEE IL
60901-5102
US

V. Phone/Fax

Practice location:
  • Phone: 815-523-7795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN AKPAN
Title or Position: PRESIDENT
Credential:
Phone: 815-523-7795