Provider Demographics
NPI:1063839553
Name:BREAD OF LIFE HOME HEALTH SVCS, INC.
Entity Type:Organization
Organization Name:BREAD OF LIFE HOME HEALTH SVCS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GODWIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANANABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-317-5259
Mailing Address - Street 1:2001 MARTIN LUTHER KING JR DR SW
Mailing Address - Street 2:SUITE 409
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1101
Mailing Address - Country:US
Mailing Address - Phone:404-564-6486
Mailing Address - Fax:404-564-6487
Practice Address - Street 1:2001 MARTIN LUTHER KING JR DR SW
Practice Address - Street 2:SUITE 409
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1101
Practice Address - Country:US
Practice Address - Phone:404-564-6486
Practice Address - Fax:404-564-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251B00000X, 251E00000X, 251S00000X, 253Z00000X, 261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health