Provider Demographics
NPI:1790753689
Name:BREATH OF LIFE, INC.
Entity Type:Organization
Organization Name:BREATH OF LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-907-8212
Mailing Address - Street 1:PO BOX 93359
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0113
Mailing Address - Country:US
Mailing Address - Phone:817-686-1111
Mailing Address - Fax:817-686-1116
Practice Address - Street 1:2612 GRAVEL DR
Practice Address - Street 2:BLDG 7
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118
Practice Address - Country:US
Practice Address - Phone:866-777-3380
Practice Address - Fax:888-882-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0066027332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174304901Medicaid
TX174304901Medicaid
AR189798716Medicaid
TX174304902Medicaid