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General NPI Number Information
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NPI Number | 1457713323
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Entity Type | Organization
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Legal Business Name | BREAKTHRU HOUSE, INC.
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 1866 EASTFIELD ST
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City | DECATUR
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State | GA
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Zip | 30032-4143
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Country | US
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Telephone | 404-284-4658
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Fax |
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Provider Business Mailing Address
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Address Line | 1866 EASTFIELD ST
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City | DECATUR
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State | GA
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Zip | 30032-4143
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Country | US
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Telephone | 404-284-4658
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. BRENITA DANLEY JACKSON
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Credential | MSW
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Telephone | 404-284-4658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 044519D
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License Number State | GA
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