MEDICARE: BREATH OF LIFE

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1518241298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATH OF LIFE

Provider Business Mailing Address
First Line	:	6400 W CAPITOL DR
Second Line	:	102
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2156
Country	:	US
Telephone Number	:	414-736-9775
Fax Number	:	414-755-0911

Provider Business Practice Location Address
First Line	:	6400 W CAPITOL DR
Second Line	:	102
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2156
Country	:	US
Telephone Number	:	414-736-9775
Fax Number	:	414-755-0911

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS LATRESHA ANN ROBINSON
Credential	:	R.N.
Telephone Number	:	414-736-9775

Provider Enumeration Date	:	09/29/2011
Last Update Date	:	09/29/2011

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Directions to “BREATH OF LIFE ” Practice Location

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