Healthcare Provider Details

I. General information

NPI: 1093542201
Provider Name (Legal Business Name): BREAKTHROUGH HEALTHCARE LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11862 LACKLAND RD
SAINT LOUIS MO
63146-4206
US

IV. Provider business mailing address

11862 LACKLAND RD
SAINT LOUIS MO
63146-4206
US

V. Phone/Fax

Practice location:
  • Phone: 314-649-5586
  • Fax: 866-203-2364
Mailing address:
  • Phone: 314-649-5586
  • Fax: 866-203-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANEKIA LINDSAY
Title or Position: OWNER
Credential:
Phone: 314-649-5586