Provider Demographics
NPI:1568288942
Name:POWERHOUSE BREATH OF LIFE
Entity type:Organization
Organization Name:POWERHOUSE BREATH OF LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISKILL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW-S
Authorized Official - Phone:804-385-8404
Mailing Address - Street 1:2663 WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5823
Mailing Address - Country:US
Mailing Address - Phone:804-385-8404
Mailing Address - Fax:804-773-4625
Practice Address - Street 1:2663 WAYSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5823
Practice Address - Country:US
Practice Address - Phone:804-385-8404
Practice Address - Fax:804-773-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty