Provider Demographics
| NPI: | 1427815638 |
|---|---|
| Name: | BREAKTHROUGH MENTAL HEALTH AND WELLNESS CENTER LLC |
| Entity type: | Organization |
| Organization Name: | BREAKTHROUGH MENTAL HEALTH AND WELLNESS CENTER LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | CHEYENNE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | COOPER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 240-650-5769 |
| Mailing Address - Street 1: | 7310 RITCHIE HWY STE 200 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | GLEN BURNIE |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 21061-3065 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 240-650-5769 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 7310 RITCHIE HWY STE 200 |
| Practice Address - Street 2: | |
| Practice Address - City: | GLEN BURNIE |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 21061-3065 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 240-650-5769 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-03-04 |
| Last Update Date: | 2024-03-05 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
| No | 251B00000X | Agencies | Case Management | |
| No | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
| No | 310500000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
| No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | |
| No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | |
| No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | |
| No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
