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General NPI Number Information
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NPI Number | 1750101028
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Entity Type | Organization
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Legal Business Name | BREAD OF LIFE CARE INC
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 3010 E DOGWOOD AVE
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City | NEWBERG
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State | OR
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Zip | 97132-1413
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Country | US
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Telephone | 503-707-2562
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 E DOGWOOD AVE
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City | NEWBERG
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State | OR
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Zip | 97132-1413
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Country | US
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Telephone | 503-707-2562
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. BRANDON PATTON
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Credential |
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Telephone | 503-707-2562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training 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 | 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 |
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