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General NPI Number Information
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NPI Number | 1134712417
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH OUTBREAKING OUTREACH MINISTRY
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 7653 BRANCHWOOD CIR
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-5801
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Country | US
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Telephone | 910-748-6991
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Fax |
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Provider Business Mailing Address
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Address Line | 7653 BRANCHWOOD CIR
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-5801
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Country | US
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Telephone | 910-748-6991
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Fax |
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Authorized Official
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Title or Position | OWNER AND PRESIDENT
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Name | MR. ALDARRIS ELLIOTT
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Credential |
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Telephone | 910-748-6991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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