MEDICARE: BREATH OF LIFE TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518199199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATH OF LIFE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	6400 W CAPITOL DR
Second Line	:	SUITE 102
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2156
Country	:	US
Telephone Number	:	414-393-9882
Fax Number	:	414-393-9982

Provider Business Practice Location Address
First Line	:	6400 W CAPITOL DR
Second Line	:	SUTIE 102
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2156
Country	:	US
Telephone Number	:	414-393-9882
Fax Number	:	414-393-9982

Authorized Official
Title or Position	:	ADMINSTRATOR/OWNER
Name	:	MS. LATRESHA ROBINSON
Credential	:	RN
Telephone Number	:	414-736-9775

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	08/17/2009

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Directions to “BREATH OF LIFE TRANSPORTATION LLC ” Practice Location

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