Provider Demographics
NPI:1467182576
Name:LIVIN' THE BREAST LIFE, LLC
Entity Type:Organization
Organization Name:LIVIN' THE BREAST LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:DEANNA
Authorized Official - Last Name:KOHLS
Authorized Official - Suffix:
Authorized Official - Credentials:CLC
Authorized Official - Phone:207-735-3737
Mailing Address - Street 1:36 GETCHELL ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2238
Mailing Address - Country:US
Mailing Address - Phone:207-573-2936
Mailing Address - Fax:
Practice Address - Street 1:36 GETCHELL ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2238
Practice Address - Country:US
Practice Address - Phone:207-573-2936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty