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General NPI Number Information
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NPI Number | 1851474225
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Entity Type | Organization
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Legal Business Name | BREAKAWAY HEALTH CORPORATION
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Dates
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Enumeration Date | 10/21/2006
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 3151 AIRWAY AVE # D-1D2
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City | COSTA MESA
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State | CA
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Zip | 92626-4607
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Country | US
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Telephone | 714-957-8229
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Fax | 714-957-0244
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Provider Business Mailing Address
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Address Line | 3151 AIRWAY AVE STE D1
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City | COSTA MESA
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State | CA
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Zip | 92626-4622
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Country | US
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Telephone | 714-957-8229
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | HANNAH PLASKETT
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Credential |
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Telephone | 714-957-8229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 300065A
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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