Provider Demographics
NPI:1205369808
Name:BREATH OF AIR HOMECARE LLC
Entity Type:Organization
Organization Name:BREATH OF AIR HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:SHAKEE
Authorized Official - Last Name:DARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-304-7603
Mailing Address - Street 1:32403 RIVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-4537
Mailing Address - Country:US
Mailing Address - Phone:757-304-7603
Mailing Address - Fax:
Practice Address - Street 1:32403 RIVERDALE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-4537
Practice Address - Country:US
Practice Address - Phone:757-304-7603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BREATH OF AIR HOMECARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X, 251G00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8211232249Medicaid
VA8211232249Medicaid
VA8211232249Medicare NSC
VA=========Medicare Oscar/Certification
VA8211232249Medicare PIN