1528245214 NPI number — BREATH OF LIFE BIRTH CENTER LLC

Table of content: (NPI 1528245214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528245214 NPI number — BREATH OF LIFE BIRTH CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREATH OF LIFE BIRTH CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BREATH OF LIFE WOMEN'S HEALTH SERVICES & BIRTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528245214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 E BAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33771-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-216-1420
Provider Business Mailing Address Fax Number:
727-216-1418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 E BAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33771-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-216-1420
Provider Business Practice Location Address Fax Number:
727-216-1418
Provider Enumeration Date:
01/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PEARSON
Authorized Official First Name:
GLENDA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
727-422-6599

Provider Taxonomy Codes

  • Taxonomy code: 261QB0400X , with the licence number:  329 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010514700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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