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General NPI Number Information
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NPI Number | 1114631918
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH HOMES LLC
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 1200 S 10TH ST UNIT 703
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-2636
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Country | US
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Telephone | 316-727-9103
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 S 10TH ST UNIT 703
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-2636
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Country | US
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Telephone | 316-727-9103
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | MARTINA MARIE KINCHION
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Credential |
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Telephone | 316-727-9103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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