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General NPI Number Information
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NPI Number | 1063839553
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Entity Type | Organization
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Legal Business Name | BREAD OF LIFE HOME HEALTH SVCS, INC.
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Dates
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Enumeration Date | 03/24/2014
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Last Update Date | 03/24/2014
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Provider Practice Location Address
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Address Line | 2001 MARTIN LUTHER KING JR DR SW SUITE 409
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City | ATLANTA
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State | GA
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Zip | 30310-1101
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Country | US
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Telephone | 404-564-6486
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Fax | 404-564-6487
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Provider Business Mailing Address
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Address Line | 2001 MARTIN LUTHER KING JR DR SW SUITE 409
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City | ATLANTA
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State | GA
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Zip | 30310-1101
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Country | US
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Telephone | 404-564-6486
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Fax | 404-564-6487
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Authorized Official
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Title or Position | CEO
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Name | DR. GODWIN A ANANABA
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Credential |
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Telephone | 770-317-5259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | GA
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