Healthcare Provider Details

I. General information

NPI: 1376226969
Provider Name (Legal Business Name): BREAKTHROUGH INTEGRATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9712 BELAIR RD STE 301
NOTTINGHAM MD
21236-1113
US

IV. Provider business mailing address

9712 BELAIR RD STE 301
NOTTINGHAM MD
21236-1113
US

V. Phone/Fax

Practice location:
  • Phone: 443-903-4874
  • Fax: 667-868-0931
Mailing address:
  • Phone: 443-903-4874
  • Fax: 667-868-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRIAN DYNELL WEST-PEARSON
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 443-902-1364