Provider Demographics
NPI:1407201924
Name:BREATH OF LIFE
Entity Type:Organization
Organization Name:BREATH OF LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORTED LIVING ARRANGEMENT PROV.
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-626-5880
Mailing Address - Street 1:1542 IRATCABAL DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-8637
Mailing Address - Country:US
Mailing Address - Phone:775-354-0707
Mailing Address - Fax:775-626-5880
Practice Address - Street 1:4944 DIANA CT
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-8634
Practice Address - Country:US
Practice Address - Phone:775-354-0707
Practice Address - Fax:775-626-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20111404144320900000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities