Provider Demographics
NPI:1285036491
Name:BREATHE
Entity Type:Organization
Organization Name:BREATHE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WINIFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:CRC/LCPC
Authorized Official - Phone:847-461-8718
Mailing Address - Street 1:329 W 102ND PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1916
Mailing Address - Country:US
Mailing Address - Phone:847-461-8718
Mailing Address - Fax:
Practice Address - Street 1:15255 S 94TH AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3800
Practice Address - Country:US
Practice Address - Phone:847-461-8718
Practice Address - Fax:847-485-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008522101Y00000X, 101YM0800X, 102L00000X
101YA0400X, 106H00000X, 251B00000X, 251S00000X, 273R00000X, 305R00000X
IL180.008522101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No273R00000XHospital UnitsPsychiatric Unit
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty