Healthcare Provider Details

I. General information

NPI: 1063384915
Provider Name (Legal Business Name): BREAKTHROUGH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2025
Last Update Date: 09/20/2025
Certification Date: 09/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 CONNECTICUT DR
CROWN POINT IN
46307-7840
US

IV. Provider business mailing address

24255 S KLEMME RD
CRETE IL
60417-2605
US

V. Phone/Fax

Practice location:
  • Phone: 708-491-8520
  • Fax:
Mailing address:
  • Phone: 708-491-8520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAKEISHA SMITH
Title or Position: CEO
Credential:
Phone: 708-491-8520