NPIMap

Organization Active NPI

Breakthrough Outbreaking Outreach Ministry

  • Peer Specialist
  • Fayetteville, NC
National Provider Identifier
1134712417
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
Legal business name
BREAKTHROUGH OUTBREAKING OUTREACH MINISTRY
Practice address
7653 Branchwood Cir
Fayetteville, NC 28314-5801
Phone
(910) 748-6991
NPI assigned
Feb 17, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Aldarris Elliott
Title
Owner and President
Phone
(910) 748-6991

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Meals Provider 174200000X
Peer SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 175T00000X Primary
Developmentally Disabled Services Day Training Agency 251C00000X
Community/Behavioral Health Agency 251S00000X
Voluntary or Charitable Agency 251V00000X

Addresses

Primary practice location

7653 Branchwood Cir
Fayetteville, NC 28314-5801

Mailing address

7653 Branchwood Cir
Fayetteville, NC 28314-5801
Phone (910) 748-6991

Other identifiers 1

IdentifierTypeStateIssuer
NAMedicaidNC

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613952000000",
    "number": "1134712417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7653 BRANCHWOOD CIR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283145801",
            "telephone_number": "910-748-6991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7653 BRANCHWOOD CIR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283145801",
            "telephone_number": "910-748-6991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKTHROUGH OUTBREAKING OUTREACH MINISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-17",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "ALDARRIS",
        "authorized_official_title_or_position": "OWNER AND PRESIDENT",
        "authorized_official_telephone_number": "910-748-6991",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NA",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.