Breakaway, Inc

LBN: Breakaway, Inc
Breakaway, Inc is an health care organization with primary practice located at 106 E 39Th St , Garden City ID 83714-6440. The organization recently has only one registered license in Suppliers / Customized Equipment, which is considered as the primary health care specialty. Breakaway, Inc can be contacted via phone (208) 342-4506, or through Elliott, Carol C via phone (208) 342-4506.

Contact Information

Primary practice address
106 E 39Th St Garden City ID 83714-6440
Phone: (208) 342-4506
Fax: (208) 342-4507
Website:
Map and Directions
Authorized official contact:
Name: Elliott, Carol C
Phone: (208) 342-4506

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Customized Equipment 332BC3200X 047307 Idaho

Profile Details

NPI number 1700055209
LBN Legal business name Breakaway, Inc
DBA Doing business as
Authorized official Elliott, Carol C
Entity Organization
Organization subpart 1 No
Enumeration date Feb 28th, 2008
Last updated Nov 30th, 2011 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700055209 NPPES
Idaho MEDICAID 8061158

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