Provider Demographics
NPI:1982621694
Name:BREATH OF LIFE LTD
Entity Type:Organization
Organization Name:BREATH OF LIFE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPIRATORY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PIZZARRO
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:CRT,RCP
Authorized Official - Phone:309-645-7430
Mailing Address - Street 1:1418 W GIFT AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-2559
Mailing Address - Country:US
Mailing Address - Phone:309-686-7135
Mailing Address - Fax:309-686-7133
Practice Address - Street 1:2201 SW ADAMS ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1803
Practice Address - Country:US
Practice Address - Phone:309-676-5645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Single Specialty