Provider Demographics
NPI:1467006635
Name:ARIZONA BREATHE RIGHT LLC
Entity Type:Organization
Organization Name:ARIZONA BREATHE RIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:II
Authorized Official - Credentials:RRT
Authorized Official - Phone:480-326-8100
Mailing Address - Street 1:1350 S ELLSWORTH RD APT 1122
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-2809
Mailing Address - Country:US
Mailing Address - Phone:480-326-1819
Mailing Address - Fax:480-522-1864
Practice Address - Street 1:1350 S ELLSWORTH RD APT 1122
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-2809
Practice Address - Country:US
Practice Address - Phone:480-326-1819
Practice Address - Fax:480-522-1864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ480036Medicaid