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General NPI Number Information
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NPI Number | 1790753689
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Entity Type | Organization
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Legal Business Name | BREATH OF LIFE, INC.
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 2612 GRAVEL DR BLDG 7
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City | FORT WORTH
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State | TX
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Zip | 76118
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Country | US
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Telephone | 866-777-3380
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Fax | 888-882-4004
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Provider Business Mailing Address
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Address Line | PO BOX 93359
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City | SOUTHLAKE
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State | TX
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Zip | 76092-0113
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Country | US
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Telephone | 817-686-1111
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Fax | 817-686-1116
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BOYCE HARBOUR
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Credential |
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Telephone | 817-907-8212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0066027
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License Number State | TX
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