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BREAKAWAY HEALTH CORPORATION NPI 1851474225


NPI Information

NPI: 1851474225
Provider Name: BREAKAWAY HEALTH CORPORATION
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 05D2105279

Address:
3151 AIRWAY AVE
D-1
COSTA MESA, CA
ZIP 92626
Phone: (714) 957-8229
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BREAKAWAY HEALTH CORPORATION is a rehabilitation and substance use disorder clinic center in Costa Mesa, CA. BREAKAWAY HEALTH CORPORATION NPI is 1851474225. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3151 AIRWAY AVE
D-1
COSTA MESA, CA
ZIP 92626-607
Phone: (714) 957-8229
Fax: (714) 957-0244

The provider's authorized official is Richard Patrick Plaskett .
The authorized official title is Executive Director and has the following contact phone number (714) 957-8229.

The CLIA number assigned to this NPI record is 05D2105279 - comp. outpatient rehab facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/21/2006 and was last updated on 5/12/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YA0400XCounselorAddiction (Substance Use Disorder)300065ACALIFORNIANo
2261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)No
3261QR0405XClinic/CenterRehabilitation, Substance Use DisorderYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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