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General NPI Number Information
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NPI Number | 1073244976
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Entity Type | Organization
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Legal Business Name | BREAD OF LIFE HOMECARE LLC
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Dates
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Enumeration Date | 06/21/2022
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 1201 11TH AVE S
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City | NASHVILLE
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State | TN
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Zip | 37203-4901
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Country | US
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Telephone | 156-244-1456
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Fax |
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Provider Business Mailing Address
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Address Line | 1033 3RD ST SE
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City | CAIRO
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State | GA
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Zip | 39828-3002
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Country | US
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Telephone | 229-289-2456
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THERESA THOMAS
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Credential |
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Telephone | 229-289-2456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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