Provider Demographics
NPI:1376873968
Name:BREATH OF LIFE, INC.
Entity Type:Organization
Organization Name:BREATH OF LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARVA
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BICKNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-727-6041
Mailing Address - Street 1:1160 GALLATIN PIKE S
Mailing Address - Street 2:SUITEE 5109, DUE WEST PROFESSIONAL BUILDING
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4624
Mailing Address - Country:US
Mailing Address - Phone:615-727-6041
Mailing Address - Fax:615-737-6001
Practice Address - Street 1:1160 GALLATIN PIKE S
Practice Address - Street 2:SUITEE 5109, DUE WEST PROFESSIONAL BUILDING
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4624
Practice Address - Country:US
Practice Address - Phone:615-727-6041
Practice Address - Fax:615-727-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care