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General NPI Number Information
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NPI Number | 1518036300
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Entity Type | Organization
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Legal Business Name | BREAD OF LIFE,LLC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13025 120TH ST
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City | LARGO
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State | FL
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Zip | 33778-1401
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Country | US
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Telephone | 727-581-0690
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Fax | 727-518-2222
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Provider Business Mailing Address
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Address Line | PO BOX 730
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City | LARGO
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State | FL
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Zip | 33779-0730
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Country | US
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Telephone | 727-581-0690
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Fax | 727-518-2222
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Authorized Official
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Title or Position | OWNER OPERATOR ADMINISTRATOR
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Name | MISS DEYON L WILLIAMS
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Credential |
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Telephone | 727-768-5066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State | FL
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