# BREAKAWAY HEALTH SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528777505
- **Authorized official:** TIM BOMBARD APRN (OWNER)
- **Authorized official phone:** (860) 214-4513

## Contact information

- **Practice address:** 843 MAIN ST \# 15, MANCHESTER, CT 06040-6020
- **Practice address phone:** (860) 648-3001
- **Practice address fax:** (860) 648-3003
- **Mailing address:** 694 PALISADO AVE, WINDSOR, CT 06095-2037
- **Mailing address phone:** (860) 214-4513

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/18/2022
- **Last updated:** 12/18/2024