Provider Demographics
NPI:1508514662
Name:BREATH OF ELEGANCE LLC
Entity Type:Organization
Organization Name:BREATH OF ELEGANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHTON
Authorized Official - Middle Name:LYNNISE
Authorized Official - Last Name:WHISENAND
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:660-833-1836
Mailing Address - Street 1:117 WEST CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:MO
Mailing Address - Zip Code:63437
Mailing Address - Country:US
Mailing Address - Phone:660-676-2896
Mailing Address - Fax:660-699-2261
Practice Address - Street 1:117 WEST CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:MO
Practice Address - Zip Code:63437
Practice Address - Country:US
Practice Address - Phone:660-676-2896
Practice Address - Fax:660-699-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies