Healthcare Provider Details

I. General information

NPI: 1538760657
Provider Name (Legal Business Name): BREAKTHROUGH BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N HOWARD ST STE 100
BALTIMORE MD
21218-5909
US

IV. Provider business mailing address

1900 N HOWARD ST STE 100
BALTIMORE MD
21218-5909
US

V. Phone/Fax

Practice location:
  • Phone: 443-445-0536
  • Fax: 443-753-4753
Mailing address:
  • Phone: 443-445-0536
  • Fax: 443-753-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: FRANCIS ODUAH
Title or Position: CEO/MEDICAL DIRECTOR
Credential: PMHNP
Phone: 443-445-0536