MEDICARE: BREATH OF LIFE, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	0066027	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790753689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATH OF LIFE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 93359
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-0113
Country	:	US
Telephone Number	:	817-686-1111
Fax Number	:	817-686-1116

Provider Business Practice Location Address
First Line	:	2612 GRAVEL DR
Second Line	:	BLDG 7
City	:	FORT WORTH
State	:	TX
Zip	:	76118
Country	:	US
Telephone Number	:	866-777-3380
Fax Number	:	888-882-4004

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BOYCE HARBOUR
Credential	:
Telephone Number	:	817-907-8212

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	05/22/2018

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Directions to “BREATH OF LIFE, INC. ” Practice Location

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