Provider Demographics
NPI: | 1437593316 |
---|---|
Name: | BREATH OF MY HEART |
Entity Type: | Organization |
Organization Name: | BREATH OF MY HEART |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHELLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PEIXINHO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LM, CPM |
Authorized Official - Phone: | 505-927-5558 |
Mailing Address - Street 1: | 705 LA JOYA ST |
Mailing Address - Street 2: | SUITE A |
Mailing Address - City: | ESPANOLA |
Mailing Address - State: | NM |
Mailing Address - Zip Code: | 87532-2235 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 505-753-0505 |
Mailing Address - Fax: | 505-212-0420 |
Practice Address - Street 1: | 705 LA JOYA ST |
Practice Address - Street 2: | SUITE A |
Practice Address - City: | ESPANOLA |
Practice Address - State: | NM |
Practice Address - Zip Code: | 87532-2235 |
Practice Address - Country: | US |
Practice Address - Phone: | 505-753-0505 |
Practice Address - Fax: | 505-212-0420 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-04-23 |
Last Update Date: | 2013-04-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NM | 03455R | 176B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 176B00000X | Other Service Providers | Midwife | Group - Multi-Specialty |