Basic Information
| Provider Information | |||||||||
| NPI: | 1861604811 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BREATH OF LIFE RESEARCH INSTITUTE INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | BREATH OF LIFE ADULT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 197 | ||||||||
| Address2: | |||||||||
| City: | BARKER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774130197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813987353 | ||||||||
| FaxNumber: | 2813987357 | ||||||||
| Practice Location | |||||||||
| Address1: | 21715 KINGSLAND BLVD | ||||||||
| Address2: | SUITE # 103 | ||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774502543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813987353 | ||||||||
| FaxNumber: | 2813987357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | OWEN | ||||||||
| AuthorizedOfficialFirstName: | GWENDOLYN | ||||||||
| AuthorizedOfficialMiddleName: | DENISE | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2813987353 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | LVN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.