Provider Demographics
NPI:1457784746
Name:EASY TO BREATHE LLC
Entity Type:Organization
Organization Name:EASY TO BREATHE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:386-288-3990
Mailing Address - Street 1:PO BOX 1952
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-1952
Mailing Address - Country:US
Mailing Address - Phone:386-288-3990
Mailing Address - Fax:386-438-5493
Practice Address - Street 1:547 NE LAKE DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3446
Practice Address - Country:US
Practice Address - Phone:386-288-3990
Practice Address - Fax:386-438-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005972000Medicaid