Provider Demographics
NPI:1922273457
Name:BREAD OF LIFE HEALTHCARE PROVIDER
Entity Type:Organization
Organization Name:BREAD OF LIFE HEALTHCARE PROVIDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:NJEAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-491-4469
Mailing Address - Street 1:9700 LEAWOOD BLVD
Mailing Address - Street 2:#302
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-2531
Mailing Address - Country:US
Mailing Address - Phone:713-491-4469
Mailing Address - Fax:
Practice Address - Street 1:9700 LEAWOOD BLVD
Practice Address - Street 2:#302
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-2531
Practice Address - Country:US
Practice Address - Phone:713-491-4469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health