Provider Demographics
NPI:1770140196
Name:BREATH OF LIFE ADULT DAY SVC
Entity type:Organization
Organization Name:BREATH OF LIFE ADULT DAY SVC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SCARLETT
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:LANGENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-822-3296
Mailing Address - Street 1:200 BUFFALO HILLS LN
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-4555
Mailing Address - Country:US
Mailing Address - Phone:218-822-3296
Mailing Address - Fax:218-454-0413
Practice Address - Street 1:200 BUFFALO HILLS LN
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-4555
Practice Address - Country:US
Practice Address - Phone:218-822-3296
Practice Address - Fax:218-454-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385H00000XRespite Care FacilityRespite Care