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General NPI Number Information
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NPI Number | 1508103441
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Entity Type | Organization
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Legal Business Name | BREATHE NEW LIFE, LLC.
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 01/11/2013
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Provider Practice Location Address
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Address Line | 4311 BROWN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-1321
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Country | US
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Telephone | 267-597-7323
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Fax |
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Provider Business Mailing Address
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Address Line | 4311 BROWN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-1321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. TAMIKA PURNELL
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Credential |
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Telephone | 267-597-7323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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