Healthcare Provider Details

I. General information

NPI: 1770140196
Provider Name (Legal Business Name): BREATH OF LIFE ADULT DAY SVC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BUFFALO HILLS LN
BRAINERD MN
56401-4555
US

IV. Provider business mailing address

200 BUFFALO HILLS LN
BRAINERD MN
56401-4555
US

V. Phone/Fax

Practice location:
  • Phone: 218-822-3296
  • Fax: 218-454-0413
Mailing address:
  • Phone: 218-822-3296
  • Fax: 218-454-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SCARLETT GRACE LANGENFELD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 218-822-3296