MEDICARE: BREAK THRU MINISTRIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	MFC34851	CA
2	251S00000X	Community/Behavioral Health Agency	MFC43015	CA
3	251S00000X	Community/Behavioral Health Agency	MFC 20752	CA

General Provider Information

NPI Number	:	1871781211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAK THRU MINISTRIES

Provider Business Mailing Address
First Line	:	3552 GREEN AVE
Second Line	:	SUITE 102
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3243
Country	:	US
Telephone Number	:	562-431-1799
Fax Number	:	562-799-9219

Provider Business Practice Location Address
First Line	:	3552 GREEN AVE
Second Line	:	SUITE 102
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3243
Country	:	US
Telephone Number	:	562-431-1799
Fax Number	:	562-799-9219

Authorized Official
Title or Position	:	DIRECTOR/PRESIDENT
Name	:	MRS. DYAN HOWK
Credential	:	M.F.T., REVEREND
Telephone Number	:	714-828-0127

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	10/11/2007

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Directions to “BREAK THRU MINISTRIES ” Practice Location

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