Provider Demographics
NPI:1255181541
Name:BREAD OF LIFE SOLUTIONS LLC
Entity type:Organization
Organization Name:BREAD OF LIFE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAUNTAE
Authorized Official - Middle Name:
Authorized Official - Last Name:CYRILLE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,RN
Authorized Official - Phone:804-651-0473
Mailing Address - Street 1:6507 WHISPERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-6289
Mailing Address - Country:US
Mailing Address - Phone:804-381-0732
Mailing Address - Fax:
Practice Address - Street 1:2947 BRIERWOOD RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2946
Practice Address - Country:US
Practice Address - Phone:804-651-0473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care