MEDICARE: BREATHE GRACE MEDICAL SUPPLY, 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1518454602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATHE GRACE MEDICAL SUPPLY, LLC

Provider Business Mailing Address
First Line	:	555 E NORTH LN STE 5075
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13179 GARRETT HWY STE C
Second Line	:
City	:	OAKLAND
State	:	MD
Zip	:	21550-1164
Country	:	US
Telephone Number	:	240-657-0030
Fax Number	:	240-657-0031

Authorized Official
Title or Position	:	CCO
Name	:	WENDY RUSSALESI
Credential	:
Telephone Number	:	484-246-9499

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	10/13/2025

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