Provider Demographics
NPI:1528245214
Name:BREATH OF LIFE BIRTH CENTER LLC
Entity type:Organization
Organization Name:BREATH OF LIFE BIRTH CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-422-6599
Mailing Address - Street 1:1900 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2218
Mailing Address - Country:US
Mailing Address - Phone:727-216-1420
Mailing Address - Fax:727-216-1418
Practice Address - Street 1:1900 E BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2218
Practice Address - Country:US
Practice Address - Phone:727-216-1420
Practice Address - Fax:727-216-1418
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BREATH OF LIFE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-25
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL329261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing