MEDICARE: BREATHE NEW LIFE, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	251E00000X	Home Health Agency
2	302R00000X	Health Maintenance Organization	PA
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1508103441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATHE NEW LIFE, LLC.

Provider Business Mailing Address
First Line	:	4311 BROWN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-1321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 BROWN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-1321
Country	:	US
Telephone Number	:	267-597-7323
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. TAMIKA PURNELL
Credential	:
Telephone Number	:	267-597-7323

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	01/11/2013

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