1609013747 NPI number — BREATH OF LIFE O2 LLC.

Table of content: (NPI 1609013747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609013747 NPI number — BREATH OF LIFE O2 LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREATH OF LIFE O2 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 HOME MEDICAL EQUIPMENT AND RESPIRATORY SERVICES INC.
Provider Other Organization Name Type Code:
4
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:
1609013747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17005 WESTFIELD PARK RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
WESTFIELD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46074-8428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-896-3048
Provider Business Mailing Address Fax Number:
866-611-5501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17005 WESTFIELD PARK RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WESTFIELD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46074-8428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-896-3048
Provider Business Practice Location Address Fax Number:
866-611-5501
Provider Enumeration Date:
01/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NAUYOKAS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
PHILLIP
Authorized Official Title or Position:
PRESIDENT/ CEO
Authorized Official Telephone Number:
317-896-3048

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6219550001 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200935180A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com