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General NPI Number Information
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NPI Number | 1861752776
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Entity Type | Organization
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Legal Business Name | BREATH OF LIFE PROFESSIONAL SERVICES, NFP, INC.
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 2725 35TH ST
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City | OAK BROOK
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State | IL
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Zip | 60523-2612
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Country | US
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Telephone | 630-570-5299
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Fax | 630-570-5298
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Provider Business Mailing Address
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Address Line | 2725 35TH ST
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City | OAK BROOK
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State | IL
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Zip | 60523-2612
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Country | US
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Telephone | 630-570-5299
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Fax | 630-570-5298
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Authorized Official
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Title or Position | EXECUIVE DIIRECTOR
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Name | MR. JACK VINCENT PRATO
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Credential | J.D.
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Telephone | 630-570-5299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | IL
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