Provider Demographics
NPI:1558842583
Name:BREATHE RESOURCES
Entity Type:Organization
Organization Name:BREATHE RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:704-310-8942
Mailing Address - Street 1:921 SKYWATCH LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-7729
Mailing Address - Country:US
Mailing Address - Phone:704-310-8942
Mailing Address - Fax:
Practice Address - Street 1:921 SKYWATCH LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-7729
Practice Address - Country:US
Practice Address - Phone:704-310-8942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22452101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1952756959Medicaid