Healthcare Provider Details

I. General information

NPI: 1073108361
Provider Name (Legal Business Name): BREAKTHROUGH IN HOME SERVICE IHS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 N LINDBERGH BLVD STE 370
HAZELWOOD MO
63042-2019
US

IV. Provider business mailing address

10630 LANDSEER DR
SAINT LOUIS MO
63136-4548
US

V. Phone/Fax

Practice location:
  • Phone: 314-400-8471
  • Fax: 314-656-1551
Mailing address:
  • Phone: 314-400-8471
  • Fax: 314-656-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE REID-WALLER
Title or Position: DIRECTOR
Credential:
Phone: 314-400-8471