Healthcare Provider Details

I. General information

NPI: 1588597231
Provider Name (Legal Business Name): BREAKTHROUGH RESIDENTIAL LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CASE ST
MORGANTON NC
28655-4112
US

IV. Provider business mailing address

108 CASE ST
MORGANTON NC
28655-4112
US

V. Phone/Fax

Practice location:
  • Phone: 828-448-4012
  • Fax:
Mailing address:
  • Phone: 828-448-4012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS QUINEKA JACKSON
Title or Position: DIRECTOR
Credential:
Phone: 980-448-4569