Provider Demographics
NPI:1639983471
Name:PUREBREATHE RESPIRATORY CARE
Entity type:Organization
Organization Name:PUREBREATHE RESPIRATORY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JR
Authorized Official - Middle Name:JESS
Authorized Official - Last Name:MATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-955-6376
Mailing Address - Street 1:8605 SANTA MONICA BLVD PMB 448053
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069
Mailing Address - Country:US
Mailing Address - Phone:702-955-6376
Mailing Address - Fax:
Practice Address - Street 1:27125 SIERRA HWY
Practice Address - Street 2:STE 325 2ND FLOOR
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351
Practice Address - Country:US
Practice Address - Phone:702-955-6376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health