NPIMap

Organization Active NPI

Breakaway Health Corporation

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Costa Mesa, CA
National Provider Identifier
1851474225
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
BREAKAWAY HEALTH CORPORATION
Practice address
3151 Airway Ave # D-1D2
Costa Mesa, CA 92626-4607
Phone
(714) 957-8229
Fax
(714) 957-0244
NPI assigned
Oct 21, 2006
Last updated
Oct 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Authorized official

Name
Hannah Plaskett
Title
Cfo
Phone
(714) 957-8229

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X NU Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Addiction (Substance Use Disorder) Counselor 101YA0400X 300065A CA

Addresses

Primary practice location

3151 Airway Ave # D-1D2
Costa Mesa, CA 92626-4607

Mailing address

3151 Airway Ave Ste D1
Costa Mesa, CA 92626-4622
Phone (714) 957-8229

Other identifiers 1

IdentifierTypeStateIssuer
300065CPOtherCADHCS LICENSE

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2105279Breakaway Health Corporation3151 Airway Ave Ste D1, Costa Mesa, CA 92626Certificate of waiverNov 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Breakaway Health Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3151 Airway Ave
Ste D1
Costa Mesa, CA 92626
Phone (714) 957-8229

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727740800000",
    "number": "1851474225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3151 AIRWAY AVE STE D1",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264622",
            "telephone_number": "714-957-8229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3151 AIRWAY AVE # D-1D2",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264607",
            "telephone_number": "714-957-8229",
            "fax_number": "714-957-0244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKAWAY HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-21",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A",
        "authorized_official_last_name": "PLASKETT",
        "authorized_official_first_name": "HANNAH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "714-957-8229"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "300065A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHCS LICENSE",
            "identifier": "300065CP",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.