Provider Demographics
NPI:1407414063
Name:A BREATH FOR LIFE LLC
Entity Type:Organization
Organization Name:A BREATH FOR LIFE LLC
Other - Org Name:SERENITY A BREATH FOR LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-615-4636
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-0217
Mailing Address - Country:US
Mailing Address - Phone:602-615-4636
Mailing Address - Fax:
Practice Address - Street 1:5626 N 51ST AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-6034
Practice Address - Country:US
Practice Address - Phone:623-930-0887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty